Foxhall Podiatry Associates, PC - Patient Payment (2022)

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'javascript:""' : 'about:blank';Ext.BLANK_IMAGE_URL = '../../Content/Images/General/BlankImage.gif';InstaMed.UniqueClientID = 'ef90a66b3bd941adb483a21a1d1aaf73';Ext.scopeResetCSS=true;InstaMed.contentUrl = 'https://instamedprd.cachefly.net/V_2022_August/';var webPropertyId = 'UA-16010902-1';InstaMed.doIdleLogout = true;InstaMed.isSSO = false;InstaMed.isSelfService = false;LogoutTimer.init();var myMask = null;InstaMed.errorMessageSummaryTitle = 'Please correct the following errors';InstaMed.requiredErrorLabel = 'Required';Ext.ns('Ext.app.REMOTING_API');Ext.app.REMOTING_API = { "id": null, "url": "../../api/Payments/New", "type": "remoting", "namespace": null, "actions": { "PatientPortalLoginController": [ { "name": "checkSession", "len": 1 }, { "name": "changeLanguage", "len": 1 }, { "name": "showBiometricLogin", "len": 1 }, { "name": "authenticateBiometricInfo", "len": 1 }, { "name": "closeAppBanner", "len": 1 }, { "name": "verifyTextEnrollment", "len": 1 }, { "name": "forgotPassword", "len": 1 }, { "name": "submit", "len": 1 }, { "name": "deleteBiometricInfo", "len": 1 }, { "name": "navigateBackFromTwoFactor", "len": 1 }, { "name": "patientMatchSubmit", "len": 1 }, { "name": "skipTextEnrollment", "len": 1 }, { "name": "authenticateTwoFactor", "len": 1 }, { "name": "redirectToLogin", "len": 1 }, { "name": "getBackButtonOverride", "len": 1 }, { "name": "patientPortalNavigateBack", "len": 1 }, { "name": "canUserResetPassword", "len": 3 }, { "name": "isEnterPayeeManuallyFlow", "len": 0 }, { "name": "logout", "len": 1 }, { "name": "sendMobilePhoneNumberConfirmationCode", "len": 1 }, { "name": "navigateTo", "len": 1 }, { "name": "patientPortalHeaderBack", "len": 1 }, { "name": "registerUserBiometricInfo", "len": 1 }, { "name": "dualLogin", "len": 1 } ], "QuickPayOptimizedProviderLandingController": [ { "name": "submitPatient", "len": 1 }, { "name": "checkQuickPayCode", "len": 1 }, { "name": "payNow", "len": 1 }, { "name": "onPatientChange", "len": 1 }, { "name": "checkQuickPayCodeOnly", "len": 1 } ], "SessionlessQuickPayReviewAndConfirmController": [ { "name": "emailReceipt", "len": 1 }, { "name": "confirm", "len": 1 }, { "name": "viewReceipt", "len": 1 }, { "name": "initializeSession", "len": 1 } ], "QuickPayPaymentSummaryController": [ { "name": "redirectToSignUp", "len": 1 }, { "name": "redirectToLogin", "len": 1 }, { "name": "redirectToPatientProfile", "len": 1 } ], "SessionlessQuickPayPaymentInfoController": [ { "name": "submitPayment", "len": 1 }, { "name": "navigateBack", "len": 1 }, { "name": "updatePaymentMethod", "len": 1 } ], "PushNotificationController": [ { "name": "navigateByPushNotification", "len": 1 } ], "PreferencesController": [ { "name": "openWindowToUpdateEmailAddress", "len": 1 }, { "name": "get_MerchantStoreTerminalAlias", "len": 0 }, { "name": "openWindowToEnterMobilePhoneNumber", "len": 1 }, { "name": "openWindowToEnterMobilePhoneNumberConfirmationCode", "len": 1 }, { "name": "updateSecurityQuestions", "len": 1 }, { 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"updateCommunicationDeliverySettings", "len": 1 } ], "PaymentActionController": [ { "name": "selectLineItem", "len": 1 }, { "name": "viewTransaction", "len": 1 }, { "name": "getNextScheduledTransaction", "len": 1 }, { "name": "getSystemWideDefault", "len": 1 }, { "name": "displayPatientInformationMutliAccount", "len": 3 }, { "name": "getAuthorization", "len": 3 }, { "name": "getPaymentPlanStatus", "len": 1 }, { "name": "getDisclaimer", "len": 1 }, { "name": "closeSSOReceipt", "len": 1 }, { "name": "voidTransactionFromHistory", "len": 1 }, { "name": "canReturnEcheck", "len": 1 }, { "name": "eCheckRefundTransactionFromHistory", "len": 1 }, { "name": "getBasePaymentTransaction", "len": 2 }, { "name": "returnToProfile", "len": 1 }, { "name": "viewReceiptByData", "len": 4 }, { "name": "canAdjustEcheck", "len": 1 }, { "name": "doReturnEcheck", "len": 1 }, { "name": "getNumberOfPaymentsRemaining", "len": 1 }, { "name": "printAll", "len": 1 }, { "name": "emailReceipt", "len": 1 }, { "name": "getReceiptConfigurationList", "len": 1 }, { "name": "downloadReceipt", "len": 1 }, { "name": "downloadCheckImage", "len": 1 }, { "name": "downloadCouponImage", "len": 1 }, { "name": "voidTransaction", "len": 1 }, { "name": "viewCheckImage", "len": 1 }, { "name": "eCheckReturn", "len": 1 }, { "name": "populateReceiptByData", "len": 5 }, { "name": "getPayeeName", "len": 3 }, { "name": "viewRefund", "len": 1 }, { "name": "creditCardRefundTransaction", "len": 2 }, { "name": "getPaymentPlan", "len": 1 }, { "name": "emailAllReceipts", "len": 1 }, { "name": "sendEmailReceipt", "len": 3 }, { "name": "canRefund", "len": 1 }, { "name": "eCheckRefundTransaction", "len": 2 }, { "name": "getBalanceRemaining", "len": 1 }, { "name": "collectNow", "len": 1 }, { "name": "eCheckAdjustment", "len": 1 }, { "name": "viewReceiptForTransaction", "len": 5 }, { "name": "viewVoid", "len": 1 }, { "name": "returnCodes", "len": 1 }, { "name": "canVoid", "len": 2 }, { "name": "populateReceipt", "len": 3 }, { "name": "displayMultiARLine", "len": 8 }, { "name": "copyPrimaryToSecondaryTransactionFieldsCommon", "len": 2 }, { "name": "creditCardRefundTransactionFromHistory", "len": 1 }, { "name": "doeCheckAdjustment", "len": 1 }, { "name": "viewReceipt", "len": 1 }, { "name": "getTransactionByData", "len": 2 }, { "name": "multiARRefundTransaction", "len": 1 }, { "name": "getTransaction", "len": 1 }, { "name": "getMultipleAccountReceiptText", "len": 3 } ], "GridController": [ { "name": "exportDataToFile", "len": 1 }, { "name": "saveColumnSortConfiguration", "len": 1 }, { "name": "saveColumnConfiguration", "len": 1 }, { "name": "updateCharts", "len": 1 }, { "name": "export", "formHandler": true, "len": 1 } ], "QuickPayLoginController": [ { "name": "login", "len": 1 }, { "name": "forgotPassword", "len": 1 }, { "name": "navigateToQuickPayLogin", "len": 1 }, { "name": "navigateBack", "len": 1 }, { "name": "navigateToQuickPaySignup", "len": 1 } ], "FileController": [ { "name": "saveHTML", "len": 1 } ], "QuickPayPaymentInfoController": [ { "name": "submitPayment", "len": 1 }, { "name": "navigateBack", "len": 1 }, { "name": "updatePaymentMethod", "len": 1 } ], "ManageAccountsController": [ { "name": "removeAccount", "len": 1 }, { "name": "saveAccountCustom", "len": 1 }, { "name": "removePaymentMethodFromRadioSelector", "len": 1 }, { "name": "saveAccount", "len": 1 }, { "name": "editAccount", "len": 1 } ], "PayAnyDocController": [ { "name": "validateAddress", "len": 1 }, { "name": "selectAddress", "len": 1 }, { "name": "getFullAddressFromPPPTile", "len": 1 }, { "name": "updateHCBPInviteTracking", "len": 1 }, { "name": "navigateTo", "len": 1 }, { "name": "cleanUp", "len": 0 }, { "name": "verifyAddress", "len": 1 }, { "name": "confirmAddress", "len": 1 }, { "name": "isExactMatch", "len": 1 }, { "name": "formatAddress", "len": 6 }, { "name": "closeWindowNavigateTo", "len": 1 }, { "name": "isExactMatchAndCorrection", "len": 1 }, { "name": "forgotPassword", "len": 1 }, { "name": "isHealthcareBillPaymentsAmountValid", "len": 1 }, { "name": "incrementViews", "len": 1 }, { "name": "updateHCBPInviteCloseCount", "len": 1 }, { "name": "getNumberOfUserViews", "len": 0 }, { "name": "getAlias", "len": 0 }, { "name": "getSessionKey", "len": 1 } ], "IdleTimerController": [ { "name": "setRemainingIdleTime", "len": 0 }, { "name": "submit", "len": 1 }, { "name": "getRemainingIdleTime", "len": 1 } ], "PatientAuthenticationController": [ { "name": "verifyPatientAccountByQuickPayCode", "len": 1 }, { "name": "skipAddPatient", "len": 1 }, { "name": "savePatientStatementAuthentication", "len": 1 }, { "name": "onStatementPatientChange", "len": 1 }, { "name": "verifyPatientAccount", "len": 1 }, { "name": "savePatientAuthenticationWithRegCode", "len": 1 }, { "name": "findPatientAuthLinkMatch", "len": 1 }, { "name": "updatePatientModule", "len": 2 }, { "name": "loadStatementData", "len": 1 }, { "name": "onPatientAuthPatientChange", "len": 1 }, { "name": "addPatient", "len": 1 }, { "name": "redirectToHome", "len": 0 }, { "name": "savePatientAuthentication", "len": 1 }, { "name": "associatePatientRecordWithUserAccount", "len": 2 } ], "MyAccountController": [ { "name": "removeProvider", "len": 1 }, { "name": "onHealthPlanChange", "len": 1 }, { "name": "hasAutoPay", "len": 1 }, { "name": "hasPaymentPlans", "len": 1 }, { "name": "loadMyProviderFeatures", "len": 0 }, { "name": "getTriggerUpdates", "len": 2 }, { "name": "removeOffNetworkPayee", "len": 1 }, { "name": "navigateToPayeeSearch", "len": 1 }, { "name": "navigateToEditAccount", "len": 1 }, { "name": "getCommunicationSettingsArray", "len": 1 }, { "name": "getCommunicationSettingsArrayInstaMedOnline", "len": 1 }, { "name": "shouldHideViewStatements", "len": 1 }, { "name": "navigateToStep", "len": 1 }, { "name": "addPayee", "len": 1 }, { "name": "shouldHideAutomaticPaymentsButton", "len": 1 }, { "name": "hasSMSEnabled", "len": 0 }, { "name": "navigateToWalletHealthPlan", "len": 1 }, { "name": "navigateToMyPreferences", "len": 1 } ], "SessionlessQuickPayGoGreenController": [ { "name": "storeEStatementPreference", "len": 1 } ], "SessionlessQuickPayPatientEntryController": [ { "name": "submitPatient", "len": 1 }, { "name": "navigateBack", "len": 1 }, { "name": "initializeSession", "len": 1 } ], "PaymentOptionsController": [ { "name": "editSelectedPaymentPlan", "len": 1 }, { "name": "submitPaymentPlan", "len": 1 }, { "name": "navigateToCustomPaymentPlan", "len": 1 }, { "name": "navigateBack", "len": 1 }, { "name": "getPaymentPlanPaymentsBreakdownWindowDetails", "len": 1 }, { "name": "navigateNext", "len": 1 }, { "name": "setSelectedOption", "len": 1 }, { "name": "navigateBackFromCustomPaymentPlan", "len": 1 }, { "name": "calculateOptions", "len": 1 } ], "PaymentHistoryController": [ { "name": "getData", "len": 1 }, { "name": "cancelVirtualCards", "len": 1 }, { "name": "searchHealthExpenses", "len": 1 }, { "name": "viewPaymentReceipt", "len": 1 }, { "name": 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"updateUserTextCommPreference", "len": 1 }, { "name": "sendEnrollmentText", "len": 1 }, { "name": "skipTextEnrollment", "len": 1 } ], "SessionlessPaymentOptionsController": [ { "name": "editSelectedPaymentPlan", "len": 1 }, { "name": "submitPaymentPlan", "len": 1 }, { "name": "navigateToCustomPaymentPlan", "len": 1 }, { "name": "navigateBack", "len": 1 }, { "name": "getPaymentPlanPaymentsBreakdownWindowDetails", "len": 1 }, { "name": "navigateNext", "len": 1 }, { "name": "setSelectedOption", "len": 1 }, { "name": "navigateBackFromCustomPaymentPlan", "len": 1 }, { "name": "calculateOptions", "len": 1 } ], "QuickPayPatientEntryController": [ { "name": "addPatient", "len": 1 }, { "name": "submitPatient", "len": 1 }, { "name": "enterInformationManually", "len": 1 }, { "name": "navigateBack", "len": 1 }, { "name": "updatePatient", "len": 1 }, { "name": "editPatientInformation", "len": 1 } ], "SettingsController": [ { "name": "load", "len": 1 }, { "name": "save", "len": 1 } ], "ResetPasswordController": [ { "name": "changePassword", "len": 1 }, { "name": "navigateFromEnterCode", "len": 1 }, { "name": "requestPasswordReset", "len": 1 }, { "name": "validateAnswer", "len": 3 }, { "name": "isDualLoginSignUpFlow", "len": 0 }, { "name": "sendResetText", "len": 1 }, { "name": "submit", "len": 1 }, { "name": "resendPasswordResetCode", "len": 1 }, { "name": "getUserId", "len": 0 }, { "name": "sendEmail", "len": 2 }, { "name": "navigateFromSelectMethodForm", "len": 1 }, { "name": "getUserInitials", "len": 1 }, { "name": "pPPResetPassword", "len": 1 }, { "name": "generateResetCode", "len": 0 }, { "name": "sendResetEmail", "len": 1 }, { "name": "navigateFromForgotPassword", "len": 1 } ], "PatientPaymentController": [ { "name": "submitCreditCard", "len": 4 }, { "name": "confirm", "len": 1 }, { "name": "setCommonTransactionFields", "len": 1 }, { "name": "cancelNewCardInfo", "len": 1 }, { "name": "displayPatientBalance", "len": 1 }, { "name": "editProviderInformation", 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"setupAutomaicPayment", "len": 2 }, { "name": "set_Transaction", "len": 1 }, { "name": "clearPayAnyDocInformation", "len": 0 }, { "name": "submitECheck", "len": 3 }, { "name": "backToNewPaymentMethod", "len": 1 }, { "name": "getPreAuthUpdateFieldInfos", "len": 1 }, { "name": "getBankAccountInfoAlreadySavedOnFile", "len": 1 }, { "name": "handleDisbursement", "len": 3 }, { "name": "savePaymentPlan", "len": 3 }, { "name": "getLineItemTransaction", "len": 1 }, { "name": "getCreditCardInfoAlreadySavedOnFile", "len": 1 } ], "PaymentPlanController": [ { "name": "setTransactionFields", "len": 2 }, { "name": "reCalculate", "len": 5 }, { "name": "backToPayment", "len": 1 }, { "name": "submitPayment", "len": 1 }, { "name": "onInstallmentAmountChange", "len": 1 }, { "name": "backToPaymentPlan", "len": 1 }, { "name": "onPatientChange", "len": 1 }, { "name": "submitPaymentPlan", "len": 1 }, { "name": "onTotalAmountChange", "len": 1 }, { "name": "onStartDateChange", "len": 1 }, { "name": "get_ScheduledTransactions", "len": 0 }, { "name": "submitPayments", "len": 1 }, { "name": "submitPatient", "len": 1 }, { "name": "get_EditPaymentPlan", "len": 0 }, { "name": "confirm", "len": 1 }, { "name": "emailReceipt", "len": 1 }, { "name": "onFrequencyChange", "len": 1 }, { "name": "onInitialAmountChange", "len": 1 }, { "name": "get_IsEditing", "len": 0 } ], "QuickPayReviewAndConfirmController": [ { "name": "emailReceipt", "len": 1 }, { "name": "confirm", "len": 1 }, { "name": "viewReceipt", "len": 1 } ], "CheckInPatientInformationController": [ { "name": "selectAddress", "len": 1 }, { "name": "onPatientChange", "len": 1 }, { "name": "next", "len": 1 }, { "name": "confirmAddress", "len": 1 } ], "MobilePayController": [ { "name": "getApplePayMerchantSession", "len": 1 } ], "SignUpController": [ { "name": "navigateFromSignUp", "len": 0 }, { "name": "completeSignUp", "len": 1 }, { "name": "redirectToSignUp", "len": 1 }, { "name": "sendAccountCreatedEvent", "len": 1 }, { "name": "signUp", "len": 1 }, { "name": "isEnterPayeeManuallyFlow", "len": 0 }, { "name": "verifyTextEnrollment", "len": 1 }, { "name": "dualSignUp", "len": 1 }, { "name": "skipTextEnrollment", "len": 1 } ], "FindProviderController": [ { "name": "goToCheckInRedirect", "len": 1 }, { "name": "search", "len": 1 }, { "name": "getManualPayeeBadge", "len": 1 }, { "name": "payNowRedirect", "len": 1 }, { "name": "clearPayAnyDocSession", "len": 1 }, { "name": "sessionSearch", "len": 1 }, { "name": "loadMyProviders", "len": 3 }, { "name": "getStore", "len": 2 }, { "name": "getVirtualCardTrustedPayeeInformation", "len": 1 }, { "name": "processStatementImage", "len": 1 }, { "name": "updateHCBPUsageTracking", "len": 2 }, { "name": "getManualPayeeInformation", "len": 1 }, { "name": "scanStatement", "len": 1 }, { "name": "enterPayeeManually", "len": 1 }, { "name": "getPatients", "len": 3 }, { "name": "landingPageSearch", "len": 1 }, { "name": "set_ZipCodeService", "len": 1 }, { "name": "searchForProviders", "len": 1 }, { "name": "getProvidersAutoComplete", "len": 1 }, { "name": "goToRedirect", "len": 1 }, { "name": "get_ZipCodeService", "len": 0 }, { "name": "getManualPayeeText", "len": 0 } ], "QuickPaySignUpController": [ { "name": "signUp", "len": 1 }, { "name": "skip", "len": 1 } ] }, "descriptor": "Ext.app.REMOTING_API"};Ext.app.REMOTING_API.maxRetries = 0;Ext.app.REMOTING_API.timeout = 300 * 1000;Ext.app.REMOTING_API.enableBuffer = false;Ext.Direct.addProvider(Ext.app.REMOTING_API);Ext.app.REMOTING_API.requestKey = 'E1D6C7F007D53DE7B23BFFD0D3E3D2CA7CC219F679475A27634703E5371690E1';Ext.app.REMOTING_API.alias = 'foxhallpodiatry';Ext.app.REMOTING_API.corporateID = '';Ext.app.REMOTING_API.token = '';function headerPatientPortalBack() { var nav = InstaMed.getNavigationView(); if(!Ext.Msg.isHidden()) { Ext.Msg.close(); } else if(nav.lastForm.length > 1) { nav.back(); } else { PerformAction({}, PatientPortalLoginController.patientPortalHeaderBack); } }Ext.define('MyApp.view.amountfield', { extend: 'Ext.field.Text', alias: 'widget.amountfield', config: { maxLength: 11, }, listeners: {blur: function(field, event, opts ){ field.doFormatAmount(field,event,opts); } }, doFormatAmount: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null && s != '') { s = s.replace(/,/g,''); s = s.replace(/\$/g,''); field.setValue(Ext.util.Format.usMoney(s)); } }, getValue: function() { var val = new String(Ext.field.Number.superclass.getValue.call(this)); if(val == "null"){val = null;} return val; }, getSubmitValue: function() { var val = this.getValue(); if(val != null){ val = val.replace(/\$/g,''); } return val; }, transformOriginalValue: function(v) { if(v != undefined && v != null && v != '') { var s = new String(v); s = s.replace(/,/g,''); s = s.replace(/\$/g,''); var val = Ext.util.Format.usMoney(s); if(val == '$NaN.undefined') { val = ''; } return val; } return v; }, reset: function() { var me = this; Ext.field.Number.superclass.reset.call(this); me.enteredDigits = []; me.totalDigitsEntered = 0; }, setValue: function(v) { if(v==null || v==undefined || v==''){ this.enteredDigits = []; this.totalDigitsEntered = 0; } if(!this.hasFocus) { if (v == '$') { v = ''; } else { v = this.transformOriginalValue(v); } } v = new String(v).replace(/[^\$\d\.\,]/g,''); if(v.indexOf('.')!=-1 && v.indexOf('.') == v.length-4){ v = v.substring(0, v.indexOf('.') + 3); v = this.transformOriginalValue(v); } if(!this.KeyUpMode) { this.enteredDigits = []; this.totalDigitsEntered = 0; var count = 0; if(v) { var chars = v.split(''); for(var i = 0; i < chars.length; i++) { var c = chars[i]; if(c >= '0' && c <= '9') { this.enteredDigits.push(c); this.totalDigitsEntered++; } } } } Ext.field.Text.superclass.setValue.call(this,v); this.setInputValue(v); } });Ext.create('Ext.data.ArrayStore',{ type: 'json', autoDestroy: false, storeId: 'ApplicationStateComboboxStore', fields: [ { name: 'code', type: 'string' }, { name: 'description', type: 'string' } ], data: [['AK', 'Alaska'],['AL', 'Alabama'],['AR', 'Arkansas'],['AS', 'American Samoa'],['AZ', 'Arizona'],['CA', 'California'],['CO', 'Colorado'],['CT', 'Connecticut'],['DC', 'District Of Columbia'],['DE', 'Delaware'],['FL', 'Florida'],['FM', 'Federated States Of Micronesia'],['GA', 'Georgia'],['GU', 'Guam'],['HI', 'Hawaii'],['IA', 'Iowa'],['ID', 'Idaho'],['IL', 'Illinois'],['IN', 'Indiana'],['KS', 'Kansas'],['KY', 'Kentucky'],['LA', 'Louisiana'],['MA', 'Massachusetts'],['MD', 'Maryland'],['ME', 'Maine'],['MH', 'Marshall Islands'],['MI', 'Michigan'],['MN', 'Minnesota'],['MO', 'Missouri'],['MP', 'Northern Mariana Islands'],['MS', 'Mississippi'],['MT', 'Montana'],['NC', 'North Carolina'],['ND', 'North Dakota'],['NE', 'Nebraska'],['NH', 'New Hampshire'],['NJ', 'New Jersey'],['NM', 'New Mexico'],['NV', 'Nevada'],['NY', 'New York'],['OH', 'Ohio'],['OK', 'Oklahoma'],['OR', 'Oregon'],['PA', 'Pennsylvania'],['PR', 'Puerto Rico'],['PW', 'Palau'],['RI', 'Rhode Island'],['SC', 'South Carolina'],['SD', 'South Dakota'],['TN', 'Tennessee'],['TX', 'Texas'],['UT', 'Utah'],['VA', 'Virginia'],['VI', 'Virgin Islands'],['VT', 'Vermont'],['WA', 'Washington'],['WI', 'Wisconsin'],['WV', 'West Virginia'],['WY', 'Wyoming'] ]})Ext.define('Ext.InstaMed.FormPanel',{extend: 'Ext.form.Panel',alias: 'widget.form',config: { defaultSubmitButton: null }});Ext.define('PatientPaymentPatientInfoMultiARDataViewModel', { extend: 'Ext.data.Model', config: { fields: [ { name: 'PaymentDate' },{ name: 'Amount' },{ name: 'PatientID' },{ name: 'PatientMedicalRecordNumber' },{ name: 'PatientFirstName' },{ name: 'PatientMiddleName' },{ name: 'PatientLastName' },{ name: 'PatientBirthDate' },{ name: 'PatientPhoneNumber' },{ name: 'AccountHolderEmail' },{ name: 'PatientInvoiceNumber' },{ name: 'PatientServiceBeginDate' },{ name: 'PatientServiceEndDate' },{ name: 'PatientAddress1' },{ name: 'PatientAddress2' },{ name: 'PatientCity' },{ name: 'PatientState' },{ name: 'PatientZip' },{ name: 'PatientCountry' },{ name: 'TransactionCode' },{ name: 'AdditionalCode1' },{ name: 'AdditionalCode2' },{ name: 'AdditionalCode3' },{ name: 'AdditionalCode4' },{ name: 'AdditionalCode5' },{ name: 'AdditionalCode6' },{ name: 'AdditionalInfo1' },{ name: 'AdditionalInfo2' },{ name: 'AdditionalInfo3' },{ name: 'AdditionalInfo4' },{ name: 'AdditionalInfo5' },{ name: 'AdditionalInfo6' },{ name: 'LineItemKey' } ] } }); Ext.create('Ext.data.Store', { id:'PatientPaymentPatientInfoMultiARDataViewstore', model: 'PatientPaymentPatientInfoMultiARDataViewModel', autoLoad: true, proxy: { type: 'memory', reader: { type: 'json' }, data: [] } }); function editLineItem(lineItemKey) { var store = InstaMed.get('PatientPaymentPatientInfoMultiARDataView').getStore(); var selIndex = store.find('LineItemKey', lineItemKey); if(selIndex >= 0) { var rec = store.getAt(selIndex); Ext.Array.each(InstaMed.getNavigationView().getCurrentItem().query('field'), function(f) { var val = rec.get(f.getName()); f.setValue(val && val.code ? val.code : val); }); } InstaMed.get('btnAddPatient').hide(); InstaMed.get('btnNext').hide(); var updatePatientButton = InstaMed.get('btnUpdatePatient'); InstaMed.get('btnCancelEditPatient').show(); var fullWidthButton = InstaMed.get('footerFullWidthButton'); if(fullWidthButton != undefined && fullWidthButton.isVisible()) { fullWidthButton.primaryButton = updatePatientButton; fullWidthButton.setText(fullWidthButton.primaryButton.getText()); fullWidthButton.forcePrimaryAction = true; } else { updatePatientButton.show(); } } function cancelEditLineItem() { InstaMed.get('btnAddPatient').show(); InstaMed.get('btnUpdatePatient').hide(); InstaMed.get('btnCancelEditPatient').hide(); InstaMed.resetForm(InstaMed.getNavigationView().getCurrentItem().query('form')[0]); var nextButton = InstaMed.get('btnNext'); var fullWidthButton = InstaMed.get('footerFullWidthButton'); if(fullWidthButton != undefined && fullWidthButton.isVisible()) { fullWidthButton.primaryButton = nextButton; fullWidthButton.setText(fullWidthButton.primaryButton.getText()); fullWidthButton.forcePrimaryAction = false; } else { nextButton.show(); } } function removeLineItem(lineItemKey) { var dataView = InstaMed.get('PatientPaymentPatientInfoMultiARDataView'); var store = dataView.getStore(); var selIndex = store.find('LineItemKey', lineItemKey); if(selIndex >= 0) { store.removeAt(selIndex); dataView.refresh(); } } function NavigateToPatientInformation(lineItemKey) { var form = InstaMed.getNavigationView(); form.push('NavPatientInformation'); if(lineItemKey) { editLineItem(lineItemKey); } PerformAction({}, PatientPaymentController.editPatientInformation); }function NavigateToQuickPayPatientEntry(lineItemKey) { var form = InstaMed.getNavigationView(); form.push('NavQuickPayPatientEntry'); if(lineItemKey) { editLineItem(lineItemKey); } javascript: PerformAction({}, QuickPayPatientEntryController.editPatientInformation,null); return false; }Ext.create('Ext.data.ArrayStore',{ type: 'json', autoDestroy: false, storeId: 'CountryStoreStore', fields: [ { name: 'code', type: 'string' }, { name: 'description', type: 'string' } ], data: [['AERO', 'Aeronautic'],['AF', 'Afghanistan'],['AX', 'Aland Islands'],['AL', 'Albania'],['DZ', 'Algeria'],['AS', 'American Samoa'],['AD', 'Andorra'],['AO', 'Angola'],['AI', 'Anguilla'],['AQ', 'Antarctica'],['AG', 'Antigua And Barbuda'],['AR', 'Argentina'],['AM', 'Armenia'],['ARPA', 'Arpanet Technical Infrastructure'],['AW', 'Aruba'],['AU', 'Australia'],['AT', 'Austria'],['AZ', 'Azerbaijan'],['BS', 'Bahamas'],['BH', 'Bahrain'],['BD', 'Bangladesh'],['BB', 'Barbados'],['BY', 'Belarus'],['BE', 'Belgium'],['BZ', 'Belize'],['BJ', 'Benin'],['BM', 'Bermuda'],['BT', 'Bhutan'],['BO', 'Bolivia'],['BA', 'Bosnia And Herzegovina'],['BW', 'Botswana'],['BV', 'Bouvet Island'],['BR', 'Brazil'],['IO', 'British Indian Ocean Territory'],['BN', 'Brunei Darussalam'],['BG', 'Bulgaria'],['BF', 'Burkina Faso'],['BI', 'Burundi'],['BIZ', 'Business'],['KH', 'Cambodia'],['CM', 'Cameroon'],['CA', 'Canada'],['CV', 'Cape Verde'],['KY', 'Cayman Islands'],['CF', 'Central African Republic'],['TD', 'Chad'],['CL', 'Chile'],['CN', 'China'],['CX', 'Christmas Island'],['CC', 'Cocos (keeling) Islands'],['CO', 'Colombia'],['COM', 'Commercial'],['KM', 'Comoros'],['CG', 'Congo'],['CK', 'Cook Islands'],['COOP', 'Cooperative'],['CR', 'Costa Rica'],['CI', 'Cote D\'ivoire (ivory Coast)'],['HR', 'Croatia (hrvatska)'],['CU', 'Cuba'],['CY', 'Cyprus'],['CZ', 'Czech Republic'],['CD', 'Democratic Republic Of The Congo'],['DK', 'Denmark'],['DJ', 'Djibouti'],['DM', 'Dominica'],['DO', 'Dominican Republic'],['TP', 'East Timor'],['EC', 'Ecuador'],['EG', 'Egypt'],['SV', 'El Salvador'],['GQ', 'Equatorial Guinea'],['ER', 'Eritrea'],['EE', 'Estonia'],['ET', 'Ethiopia'],['FK', 'Falkland Islands (malvinas)'],['FO', 'Faroe Islands'],['FM', 'Federated States Of Micronesia'],['FJ', 'Fiji'],['FI', 'Finland'],['FR', 'France'],['FX', 'France, Metropolitan'],['GF', 'French Guiana'],['PF', 'French Polynesia'],['TF', 'French Southern Territories'],['GA', 'Gabon'],['GM', 'Gambia'],['GE', 'Georgia'],['DE', 'Germany'],['GH', 'Ghana'],['GI', 'Gibraltar'],['GB', 'Great Britain (uk)'],['GR', 'Greece'],['GL', 'Greenland'],['GD', 'Grenada'],['GP', 'Guadeloupe'],['GU', 'Guam'],['GT', 'Guatemala'],['GN', 'Guinea'],['GW', 'Guinea-bissau'],['GY', 'Guyana'],['HT', 'Haiti'],['HM', 'Heard Island And Mcdonald Islands'],['HN', 'Honduras'],['HK', 'Hong Kong'],['HU', 'Hungary'],['IS', 'Iceland'],['IN', 'India'],['ID', 'Indonesia'],['INFO', 'Info Domain'],['INT', 'International'],['IR', 'Iran'],['IQ', 'Iraq'],['IE', 'Ireland'],['IL', 'Israel'],['IT', 'Italy'],['JM', 'Jamaica'],['JP', 'Japan'],['JO', 'Jordan'],['KZ', 'Kazakhstan'],['KE', 'Kenya'],['KI', 'Kiribati'],['KP', 'Korea (north)'],['KR', 'Korea (south)'],['KW', 'Kuwait'],['KG', 'Kyrgyzstan'],['LA', 'Laos'],['LV', 'Latvia'],['LB', 'Lebanon'],['LS', 'Lesotho'],['LR', 'Liberia'],['LY', 'Libya'],['LI', 'Liechtenstein'],['LT', 'Lithuania'],['LU', 'Luxembourg'],['MO', 'Macao'],['MK', 'Macedonia'],['MG', 'Madagascar'],['MW', 'Malawi'],['MY', 'Malaysia'],['MV', 'Maldives'],['ML', 'Mali'],['MT', 'Malta'],['MH', 'Marshall Islands'],['MQ', 'Martinique'],['MR', 'Mauritania'],['MU', 'Mauritius'],['YT', 'Mayotte'],['MX', 'Mexico'],['MD', 'Moldova'],['MC', 'Monaco'],['MN', 'Mongolia'],['MS', 'Montserrat'],['MA', 'Morocco'],['MZ', 'Mozambique'],['MM', 'Myanmar'],['NA', 'Namibia'],['NR', 'Nauru'],['NP', 'Nepal'],['NL', 'Netherlands'],['AN', 'Netherlands Antilles'],['NET', 'Network'],['NC', 'New Caledonia'],['NZ', 'New Zealand (aotearoa)'],['NI', 'Nicaragua'],['NE', 'Niger'],['NG', 'Nigeria'],['NU', 'Niue'],['ORG', 'Nonprofit Organization'],['NF', 'Norfolk Island'],['NATO', 'North Atlantic Treaty Organization'],['MP', 'Northern Mariana Islands'],['NO', 'Norway'],['OM', 'Oman'],['PK', 'Pakistan'],['PW', 'Palau'],['PS', 'Palestinian Territory'],['PA', 'Panama'],['PG', 'Papua New Guinea'],['PY', 'Paraguay'],['NAME', 'Personal Name'],['PE', 'Peru'],['PH', 'Philippines'],['PN', 'Pitcairn'],['PL', 'Poland'],['PT', 'Portugal'],['PRO', 'Professional Services'],['PR', 'Puerto Rico'],['QA', 'Qatar'],['RE', 'Reunion'],['RO', 'Romania'],['RU', 'Russian Federation'],['RW', 'Rwanda'],['GS', 'S. Georgia And S. Sandwich Islands'],['SH', 'Saint Helena'],['KN', 'Saint Kitts And Nevis'],['LC', 'Saint Lucia'],['PM', 'Saint Pierre And Miquelon'],['VC', 'Saint Vincent And The Grenadines'],['WS', 'Samoa'],['SM', 'San Marino'],['ST', 'Sao Tome And Principe'],['SA', 'Saudi Arabia'],['SN', 'Senegal'],['CS', 'Serbia And Montenegro'],['SC', 'Seychelles'],['SL', 'Sierra Leone'],['SG', 'Singapore'],['SK', 'Slovakia'],['SI', 'Slovenia'],['SB', 'Solomon Islands'],['SO', 'Somalia'],['ZA', 'South Africa'],['ES', 'Spain'],['LK', 'Sri Lanka'],['SD', 'Sudan'],['SR', 'Suriname'],['SJ', 'Svalbard And Jan Mayen'],['SZ', 'Swaziland'],['SE', 'Sweden'],['CH', 'Switzerland'],['SY', 'Syria'],['TW', 'Taiwan'],['TJ', 'Tajikistan'],['TZ', 'Tanzania'],['TH', 'Thailand'],['TL', 'Timor-leste'],['TG', 'Togo'],['TK', 'Tokelau'],['TO', 'Tonga'],['TT', 'Trinidad And Tobago'],['TN', 'Tunisia'],['TR', 'Turkey'],['TM', 'Turkmenistan'],['TC', 'Turks And Caicos Islands'],['TV', 'Tuvalu'],['UG', 'Uganda'],['UA', 'Ukraine'],['AE', 'United Arab Emirates'],['UK', 'United Kingdom'],['US', 'United States'],['UM', 'United States Minor Outlying Islands'],['UY', 'Uruguay'],['EDU', 'Us Educational'],['GOV', 'Us Government'],['MIL', 'Us Military'],['SU', 'Ussr (former)'],['UZ', 'Uzbekistan'],['VU', 'Vanuatu'],['VA', 'Vatican City State (holy See)'],['VE', 'Venezuela'],['VN', 'Viet Nam'],['VG', 'Virgin Islands (british)'],['VI', 'Virgin Islands (u.s.)'],['WF', 'Wallis And Futuna'],['EH', 'Western Sahara'],['YE', 'Yemen'],['YU', 'Yugoslavia (former)'],['ZR', 'Zaire (former)'],['ZM', 'Zambia'],['ZW', 'Zimbabwe'] ]})Ext.define('MyApp.model.CodeDescriptionAccountSummaryPaymentInformationStore',{extend: 'Ext.data.Model',id: 'AccountSummaryPaymentInformationStore',fields: [{name:'Angle'},{name:'Label'},{name:'Color'},{name:'IsMaxAngle'}]});Ext.create('Ext.data.JsonStore',{ autoDestroy: false, proxy: { type: 'memory', reader: 'json', writer: 'json' }, storeId: 'AccountSummaryPaymentInformationStore', fields: [{ name: 'Angle', type: 'string'},{ name: 'Label', type: 'string'},{ name: 'Color', type: 'string'},{ name: 'IsMaxAngle', type: 'string'}],data: [{"Angle":"360","Label":"Total Balance","Color":"#005596","IsMaxAngle":true,"EntityID":null}]});Ext.define('Ext.chart.theme.instamed', { extend: 'Ext.chart.theme.Base', singleton: true, alias: 'chart.theme.instamed', config: { colors: ["#1976D2","#A5D6A7","#039BE5","#4A148C","#4CAF50","#9575CD","#C51162","#FB8C00","#880E4F","#E57373","#90A4AE"] } });function removeProvider(providerAlias) { var providerName = Ext.StoreManager.get('MyAccountProvidersList-init').findRecord('ProviderAlias', providerAlias).get('ProviderName');var payeeName = providerName;if(!payeeName){payeeName = 'This Payee'}if(InstaMed.isMobileOrTablet){Ext.Msg.show({title: 'Remove',message: 'Remove ' + payeeName + ' ?',buttons: [{text: 'Cancel',ui: 'decline',itemId: 'no'}, {text: 'Remove',ui: 'confirm',itemId: 'yes'}],fn: function(btn) {if (btn === 'yes') {PerformAction({ProviderAlias: providerAlias, ProviderName: providerName}, MyAccountController.removeProvider); }}}); }else{ Ext.Msg.buttonText.cancel = Ext.util.Format.htmlEncode('Cancel'); Ext.Msg.buttonText.ok = Ext.util.Format.htmlEncode('Ok'); Ext.Msg.show({title: 'Please Confirm',msg: 'Remove ' + payeeName + '?',icon: Ext.Msg.QUESTION,buttons: Ext.Msg.OKCANCEL,iconWidth:54,iconHeight:45,fn: function(btn) {if (btn === 'ok') {PerformAction({ProviderAlias: providerAlias, ProviderName: providerName}, MyAccountController.removeProvider);}} });} event && event.stopPropagation(); }function removeOffNetworkPayee(entityID, payeeName){ if(InstaMed.isMobileOrTablet){Ext.Msg.show({title: 'Remove',message: 'Remove ' + payeeName + ' ?',buttons: [{text: 'Cancel',ui: 'decline',itemId: 'no'}, {text: 'Remove',ui: 'confirm',itemId: 'yes'}],fn: function(btn) {if (btn === 'yes') {PerformAction({EntityID: entityID, ProviderName: payeeName}, MyAccountController.removeOffNetworkPayee); }}}); }else{ Ext.Msg.buttonText.cancel = Ext.util.Format.htmlEncode('Cancel'); Ext.Msg.buttonText.ok = Ext.util.Format.htmlEncode('Ok'); Ext.Msg.show({title: 'Please Confirm',msg: 'Remove ' + payeeName + '?',icon: Ext.Msg.QUESTION,buttons: Ext.Msg.OKCANCEL,iconWidth:54,iconHeight:45,fn: function(btn) {if (btn === 'ok') {PerformAction({EntityID: entityID, ProviderName: payeeName}, MyAccountController.removeOffNetworkPayee);}} });} event && event.stopPropagation();}function registerRemovePayeeTooltip(providerAlias) {Ext.tip.QuickTipManager.register({target: 'remove-payee-icon-' + providerAlias,text : 'Remove',showDelay: 125});}function registerAllRemovePayeeTooltips() { var store = Ext.StoreManager.get('MyAccountProvidersList-init'); if(store) {for(var i = 0; i < store.getTotalCount(); i++){var rec = store.getAt(i);registerRemovePayeeTooltip(rec.get('ProviderAlias')); } }} function EncodeApostropheAndURIComponent (str) { return InstaMed.encodeApostrophe(encodeURIComponent(str)); } function payeeTileRedirect(alias, visit, payment, add, select, pk, memberpay,trackingData, autoCompleteName, location) { var dataView = InstaMed.get('ProviderBadges'); if(dataView && dataView.lastStoreUpdate && (Math.floor(Date.now()) - dataView.lastStoreUpdate < 1000)){ return;}; var pageNum = 1; if(dataView) pageNum = dataView.getStore().currentPage; var navPage = Ext.get('NavFindProvider') var scrollLocation = 0; if (navPage && navPage.child) { var container = navPage.child('div', false); if(container && container.child) { var scroller = container.child('div[class*=x-scroller]', false); if(scroller && scroller.dom.scroll) { scrollLocation = scroller.dom.scrollTop; } } } PerformAction({ ProviderAlias: alias, isVisit: visit, isPayment: payment, isAdd: add, isSelect: select, isMemberPayment: memberpay, OffNetworkPK: pk,Origin:null, trackingData: trackingData, pageNumber: pageNum, scrollLocation: scrollLocation, autoCompleteName: autoCompleteName, location: location }, FindProviderController.enterPayeeManually); event && event.stopPropagation();}function handlePayNow(alias, pk) {PerformAction({ ProviderAlias: alias, OffNetworkPK: pk}, FindProviderController.payNowRedirect); event && event.stopPropagation();}function handleGoTo(alias, pk) {PerformAction({ ProviderAlias: alias, OffNetworkPK: pk}, FindProviderController.goToRedirect); event && event.stopPropagation();} function handleGoToCheckIn(alias) { PerformAction({ ProviderAlias: alias}, FindProviderController.goToCheckInRedirect); event && event.stopPropagation(); } function closeMenu(){ var dropdowns = document.getElementsByClassName("dropdown-content");var i;for (i = 0; i x.data.PaymentPlanID === 'NEW' && x.data.PaymentType === 'CreditCard') if(storeItems.length > 1){ store.insert(index, {PaymentType: 'GooglePay', AccountType: 'GooglePay', EditPaymentPlanID: 'GooglePay', PaymentAccount: 'GooglePay', id: 'GooglePay', PaymentPlanID: 'GooglePay', AccountNickname: 'Google Pay', IconCls:'googlePayCls', ShowAllFields: false}); } else{ store.insert(index - 1, {PaymentType: 'GooglePay', AccountType: 'GooglePay', EditPaymentPlanID: 'GooglePay', PaymentAccount: 'GooglePay', id: 'GooglePay', PaymentPlanID: 'GooglePay', AccountNickname: 'Google Pay', IconCls:'googlePayCls', ShowAllFields: false}); } } } }function getPaymentMethodDefaultOnLoad(cmp){ if(window.runPaymentMethodSelectorPaintEvent == undefined) { window.runPaymentMethodSelectorPaintEvent = true; }; if(window.runPaymentMethodSelectorPaintEvent){ var storeCmp = InstaMed.get('PaymentMethodSelectionDataViewComponent'); if(storeCmp) { var store = storeCmp.getStore(); var payments = store.data.items; var hasDefault = false; var ccContainer = InstaMed.get('creditCardInfoContainer'); var checkContainer = InstaMed.get('checkInfoContainer'); var emptyContainer = InstaMed.get('PaymentMethodSelectionEmptyContainer'); var removeBtn = InstaMed.get('btnRemove'); var paymentBankAccountDefault = InstaMed.get('PaymentBankAccountDefault'); var googlePaySupported = InstaMed.get('GooglePaySupported'); var applePaySupported = InstaMed.get('ApplePaySupported'); var startInEditMode = false; var isECheckNewPaymentMethodSelected = false; var isCreditNewPaymentMethodSelected = false; var indexRadio = null; resetPaymentMethodInfoFields(cmp); removeBtn && removeBtn.innerElement.getFirstChild().addCls('x-link-red x-button'); removeBtn && removeBtn.innerElement.addCls('zero-left-padding'); if(payments.length > 0){ payments.forEach((payment, index) => { if(InstaMed.isTrue(payment.data.IsDefaultPaymentMethod)){ if(payment.data.PaymentPlanID != 'NEW'){ InstaMed.get('PaymentMethodRadioOption').resetGroupValues(); InstaMed.get('PaymentMethodRadioOption').setGroupValue(payment.data.PaymentPlanID); var editMode = InstaMed.get('EditMode'); hasDefault = true; startInEditMode = payment.data.StartInEditMode; editMode.setValue(payment.data.IsEditable) var paymentType = payment.data.PaymentType; indexRadio = index; if (!payment.data.CardHolderCountry) { payment.data.CardHolderCountry = 'US'; } InstaMed.get('CardHolderName') && InstaMed.get('CardHolderName').setValue(payment.data.NameOnCard); InstaMed.get('CreditCardNumber') && InstaMed.get('CreditCardNumber').setValue(payment.data.CardNumber); InstaMed.get('ExpMonth') && InstaMed.get('ExpMonth').setValue(payment.data.ExpMonth); InstaMed.get('ExpYear') && InstaMed.get('ExpYear').setValue(payment.data.ExpYear); InstaMed.get('CVN') && InstaMed.get('CVN').setValue(payment.data.CVN); InstaMed.get('CreditCardAccountHolderAddress1') && InstaMed.get('CreditCardAccountHolderAddress1').setValue(payment.data.CardHolderAddress1); InstaMed.get('CreditCardAccountHolderAddress2') && InstaMed.get('CreditCardAccountHolderAddress2').setValue(payment.data.CardHolderAddress2); InstaMed.get('CreditCardAccountHolderCity') && InstaMed.get('CreditCardAccountHolderCity').setValue(payment.data.CardHolderCity); InstaMed.get('CreditCardAccountHolderState') && InstaMed.get('CreditCardAccountHolderState').setValue(payment.data.CardHolderState); InstaMed.get('CreditCardAccountHolderZip') && InstaMed.get('CreditCardAccountHolderZip').setValue(payment.data.CardHolderZip); InstaMed.get('CreditCardAccountHolderCountry') && InstaMed.get('CreditCardAccountHolderCountry').setValue(payment.data.CardHolderCountry); InstaMed.get('CreditCardAccountHolderPhoneNumber') && InstaMed.get('CreditCardAccountHolderPhoneNumber').setValue(payment.data.CardHolderPhoneNumber); InstaMed.get('CheckingAccountHolderFirstName') && InstaMed.get('CheckingAccountHolderFirstName').setValue(payment.data.CheckHolderFirstName); InstaMed.get('CheckingAccountHolderLastName') && InstaMed.get('CheckingAccountHolderLastName').setValue(payment.data.CheckHolderLastName); InstaMed.get('CheckingAccountType') && InstaMed.get('CheckingAccountType').setValue(payment.data.CheckAccountType); InstaMed.get('RoutingNumber') && InstaMed.get('RoutingNumber').setValue(payment.data.RoutingNumber); InstaMed.get('CheckingAccountNumber') && InstaMed.get('CheckingAccountNumber').setValue(payment.data.AccountNumber); InstaMed.get('CheckingAccountHolderState') && InstaMed.get('CheckingAccountHolderState').setValue(payment.data.CheckHolderState); InstaMed.get('CheckingAccountHolderAddress1') && InstaMed.get('CheckingAccountHolderAddress1').setValue(payment.data.CheckHolderStreet1); InstaMed.get('CheckingAccountHolderAddress2') && InstaMed.get('CheckingAccountHolderAddress2').setValue(payment.data.CheckHolderStreet2); InstaMed.get('CheckingAccountHolderCity') && InstaMed.get('CheckingAccountHolderCity').setValue(payment.data.CheckHolderCity); InstaMed.get('CheckingAccountHolderZip') && InstaMed.get('CheckingAccountHolderZip').setValue(payment.data.CheckHolderZip); InstaMed.get('CheckingAccountHolderPhoneNumber') && InstaMed.get('CheckingAccountHolderPhoneNumber').setValue(payment.data.CheckHolderPhoneNumber); InstaMed.get('CheckingAccountHolderDriversLicense') && InstaMed.get('CheckingAccountHolderDriversLicense').setValue(payment.data.CheckHolderDriversLicense); InstaMed.get('AccountType') && InstaMed.get('AccountType').setValue(paymentType); InstaMed.get('EditPaymentPlanID') && InstaMed.get('EditPaymentPlanID').setValue(payment.data.PaymentPlanID); InstaMed.get('PaymentAccount') && InstaMed.get('PaymentAccount').setValue(payment.data.PaymentPlanID); InstaMed.get('EntityID') && InstaMed.get('EntityID').setValue(payment.data.EntityID); InstaMed.get('PaymentType') && InstaMed.get('PaymentType').setValue(payment.data.PaymentPlanID); InstaMed.get('Label') && InstaMed.get('Label').setValue(payment.data.AccountNickname); } else { if(payment.data.PaymentType == 'CreditCard'){ isCreditNewPaymentMethodSelected = true; indexRadio = index; } if(payment.data.PaymentType == 'ECheck'){ isECheckNewPaymentMethodSelected = true; indexRadio = index; } } } } ); if(hasDefault && !startInEditMode || !hasDefault){ if(checkContainer){ emptyContainer && emptyContainer.add(checkContainer); } if(ccContainer){ emptyContainer && emptyContainer.add(ccContainer); } if(removeBtn){ emptyContainer && emptyContainer.add(removeBtn); } ccContainer &&ccContainer.hide(); checkContainer && checkContainer.hide(); removeBtn && removeBtn.hide(); } if(!hasDefault){ if(payments.length == 1 && !(googlePaySupported && googlePaySupported.getValue()) && !(applePaySupported && applePaySupported.getValue()) ) { checkContainer && checkContainer.hide(); ccContainer && ccContainer.hide(); InstaMed.get('PaymentMethodRadioOption').setGroupValue(payments[0].data.PaymentPlanID); if(payments[0].data.PaymentType == 'CreditCard'){ ccContainer && ccContainer.show(); } else if(payments[0].data.PaymentType == 'ECheck'){ checkContainer && checkContainer.show(); } } } if(indexRadio !=null){ var radioOpts = document.getElementsByName('PaymentMethodRadioOption'); Ext.Array.forEach(radioOpts, function(cmpRadio, index){ if(index == indexRadio){ InstaMed.get('PaymentMethodRadioOption').resetGroupValues(); cmpRadio.click(); } }); } } } } window.runPaymentMethodSelectorPaintEvent = true; }function removePaymentMethodSuccessStoreUpdate(cmp){ window.runPaymentMethodSelectorPaintEvent = true; var entityID = InstaMed.get('EntityID').getValue(); var ccContainer = InstaMed.get('creditCardInfoContainer'); var checkContainer = InstaMed.get('checkInfoContainer'); var removeBtn = InstaMed.get('btnRemove'); var emptyContainer = InstaMed.get('PaymentMethodSelectionEmptyContainer'); emptyContainer.add(checkContainer); emptyContainer.add(ccContainer); emptyContainer.add(removeBtn); ccContainer.hide(); checkContainer.hide(); removeBtn.hide(); var storeCmp = InstaMed.get('PaymentMethodSelectionDataViewComponent'); if(storeCmp) { var store = storeCmp.getStore(); var dataFromStore = store.data; var index = dataFromStore.items.findIndex(x => x.data.EntityID === entityID); dataFromStore.removeAt(index); getPaymentMethodDefaultOnLoad(cmp); } }function resetPaymentMethodInfoFields(cmp){ InstaMed.get('CardHolderName') && InstaMed.get('CardHolderName').setValue(null); InstaMed.get('CreditCardNumber') && InstaMed.get('CreditCardNumber').setValue(null); InstaMed.get('ExpMonth') && InstaMed.get('ExpMonth').setValue(null); InstaMed.get('ExpYear') && InstaMed.get('ExpYear').setValue(null); InstaMed.get('CVN') && InstaMed.get('CVN').setValue(null); InstaMed.get('CreditCardAccountHolderAddress1') && InstaMed.get('CreditCardAccountHolderAddress1').setValue(null); InstaMed.get('CreditCardAccountHolderAddress2') && InstaMed.get('CreditCardAccountHolderAddress2').setValue(null); InstaMed.get('CreditCardAccountHolderCity') && InstaMed.get('CreditCardAccountHolderCity').setValue(null); InstaMed.get('CreditCardAccountHolderState') && InstaMed.get('CreditCardAccountHolderState').setValue(null); InstaMed.get('CreditCardAccountHolderZip') && InstaMed.get('CreditCardAccountHolderZip').setValue(null); InstaMed.get('CreditCardAccountHolderPhoneNumber') && InstaMed.get('CreditCardAccountHolderPhoneNumber').setValue(null); InstaMed.get('CheckingAccountHolderFirstName') && InstaMed.get('CheckingAccountHolderFirstName').setValue(null); InstaMed.get('CheckingAccountHolderLastName') && InstaMed.get('CheckingAccountHolderLastName').setValue(null); InstaMed.get('CheckingAccountType') && InstaMed.get('CheckingAccountType').setValue(null); InstaMed.get('RoutingNumber') && InstaMed.get('RoutingNumber').setValue(null); InstaMed.get('CheckingAccountHolderAddress1') && InstaMed.get('CheckingAccountHolderAddress1').setValue(null); InstaMed.get('CheckingAccountHolderAddress2') && InstaMed.get('CheckingAccountHolderAddress2').setValue(null); InstaMed.get('CheckingAccountHolderCity') && InstaMed.get('CheckingAccountHolderCity').setValue(null); InstaMed.get('CheckingAccountHolderZip') && InstaMed.get('CheckingAccountHolderZip').setValue(null); InstaMed.get('CheckingAccountNumber') && InstaMed.get('CheckingAccountNumber').setValue(null); InstaMed.get('CheckingAccountHolderState') && InstaMed.get('CheckingAccountHolderState').setValue(null); InstaMed.get('CheckingAccountHolderPhoneNumber') && InstaMed.get('CheckingAccountHolderPhoneNumber').setValue(null); InstaMed.get('CheckingAccountHolderDriversLicense') && InstaMed.get('CheckingAccountHolderDriversLicense').setValue(null); InstaMed.get('AccountType') && InstaMed.get('AccountType').setValue(null); InstaMed.get('EditPaymentPlanID') && InstaMed.get('EditPaymentPlanID').setValue(null); InstaMed.get('PaymentAccount') && InstaMed.get('PaymentAccount').setValue(null); InstaMed.get('EntityID') && InstaMed.get('EntityID').setValue(null); InstaMed.get('PaymentType') && InstaMed.get('PaymentType').setValue(null); InstaMed.get('Label') && InstaMed.get('Label').setValue(null); InstaMed.get('APCNotSupportedMessageContainer') && InstaMed.get('APCNotSupportedMessageContainer').hide(); var form = InstaMed.getActiveForm(); form.clearInvalid(); InstaMed.clearValidation(form); }function setCardTypeIconCLS() { var cardType = InstaMed.get('CardType'); var creditCardField = InstaMed.get('CreditCardNumber'); if(cardType && creditCardField) { var triggers = creditCardField.getTriggers(); if (triggers && triggers.VISATrigger) { creditCardField.removeTrigger('VISATrigger'); } if (triggers && triggers.AmexTrigger) { creditCardField.removeTrigger('AmexTrigger'); } if (triggers && triggers.DiscoveryTrigger) { creditCardField.removeTrigger('DiscoveryTrigger'); } if (triggers && triggers.MasterCardTrigger) { creditCardField.removeTrigger('MasterCardTrigger'); } if (triggers && triggers.OtherCardsTrigger) { creditCardField.removeTrigger('OtherCardsTrigger'); } if(InstaMed.isTrue('False')){ cardType.setValue(''); } var cardTypeValue = cardType.getValue(); if(cardTypeValue) { cardTypeValue = cardTypeValue.toUpperCase(); if(cardTypeValue != 'INITIAL') { if(cardTypeValue == 'MC') { if (triggers && !triggers.MasterCardTrigger) { creditCardField.addTrigger('MasterCardTrigger',{cls:'mastercardCls',type: 'cardIcon'}); } } else if(cardTypeValue == 'VISA') { if (triggers && !triggers.VISATrigger) { creditCardField.addTrigger('VISATrigger',{cls:'visaCls',type: 'cardIcon'}); } } else if(cardTypeValue == 'AMEX') { if (triggers && !triggers.AmexTrigger) { creditCardField.addTrigger('AmexTrigger',{cls:'amexCls',type: 'cardIcon'}); } } else if(cardTypeValue == 'DISCOVER') { if (triggers && !triggers.DiscoveryTrigger) { creditCardField.addTrigger('DiscoveryTrigger',{cls:'discoverCls',type: 'cardIcon'}); } } else if(cardTypeValue == 'OTHER') { if (triggers && !triggers.OtherCardsTrigger) { creditCardField.addTrigger('OtherCardsTrigger',{cls:'echeckCls',type: 'cardIcon'}); } } } } else { if (triggers && !triggers.VISATrigger && true) { creditCardField.addTrigger('VISATrigger',{cls:'visaCls',type: 'cardIcon'}); } if (triggers && !triggers.DiscoveryTrigger && true) { creditCardField.addTrigger('DiscoveryTrigger',{cls:'discoverCls',type: 'cardIcon'}); } if (triggers && !triggers.MasterCardTrigger && true) { creditCardField.addTrigger('MasterCardTrigger',{cls:'mastercardCls',type: 'cardIcon'}); } if (triggers && !triggers.AmexTrigger && true) { creditCardField.addTrigger('AmexTrigger',{cls:'amexCls',type: 'cardIcon'}); } if (triggers && !triggers.OtherCardsTrigger && false) { creditCardField.addTrigger('OtherCardsTrigger',{cls:'echeckCls',type: 'cardIcon'}); } } } }Ext.define('MyApp.model.CodeDescriptionpaymentMethodRadioSelectorStore',{extend: 'Ext.data.Model',id: 'paymentMethodRadioSelectorStore',fields: [{name:'IconCls'},{name:'PaymentPlanID'},{name:'AccountNickname'},{name:'PaymentType'},{name:'IsDefaultPaymentMethod'},{name:'StartInEditMode'},{name:'IsEditable'},{name:'ShowAllFields'},{name:'NameOnCard'},{name:'CardNumber'},{name:'CardHolderDriversLicense'},{name:'ExpDate'},{name:'ExpMonth'},{name:'ExpYear'},{name:'CardHolderAddress1'},{name:'CardHolderAddress2'},{name:'CardHolderCity'},{name:'CardHolderState'},{name:'CardHolderZip'},{name:'CardHolderCountry'},{name:'CardHolderPhoneNumber'},{name:'CVN'},{name:'CheckHolderFirstName'},{name:'CheckHolderLastName'},{name:'RoutingNumber'},{name:'AccountNumber'},{name:'CheckHolderStreet1'},{name:'CheckHolderStreet2'},{name:'CheckHolderCity'},{name:'CheckHolderZip'},{name:'CheckHolderState'},{name:'CheckHolderPhoneNumber'},{name:'CheckHolderName'},{name:'CheckHolderDriversLicense'},{name:'CheckAccountType'},{name:'CheckHolderCountry'},{name:'EntityID'}]});Ext.create('Ext.data.JsonStore',{ autoDestroy: false, proxy: { type: 'memory', reader: 'json', writer: 'json' }, storeId: 'paymentMethodRadioSelectorStore', fields: [{ name: 'IconCls', type: 'auto'},{ name: 'PaymentPlanID', type: 'auto'},{ name: 'AccountNickname', type: 'auto'},{ name: 'PaymentType', type: 'auto'},{ name: 'IsDefaultPaymentMethod', type: 'auto'},{ name: 'StartInEditMode', type: 'boolean'},{ name: 'IsEditable', type: 'boolean'},{ name: 'ShowAllFields', type: 'boolean'},{ name: 'NameOnCard', type: 'auto'},{ name: 'CardNumber', type: 'auto'},{ name: 'CardHolderDriversLicense', type: 'auto'},{ name: 'ExpDate', type: 'auto'},{ name: 'ExpMonth', type: 'auto'},{ name: 'ExpYear', type: 'auto'},{ name: 'CardHolderAddress1', type: 'auto'},{ name: 'CardHolderAddress2', type: 'auto'},{ name: 'CardHolderCity', type: 'auto'},{ name: 'CardHolderState', type: 'auto'},{ name: 'CardHolderZip', type: 'auto'},{ name: 'CardHolderCountry', type: 'auto'},{ name: 'CardHolderPhoneNumber', type: 'auto'},{ name: 'CVN', type: 'auto'},{ name: 'CheckHolderFirstName', type: 'auto'},{ name: 'CheckHolderLastName', type: 'auto'},{ name: 'RoutingNumber', type: 'auto'},{ name: 'AccountNumber', type: 'auto'},{ name: 'CheckHolderStreet1', type: 'auto'},{ name: 'CheckHolderStreet2', type: 'auto'},{ name: 'CheckHolderCity', type: 'auto'},{ name: 'CheckHolderZip', type: 'auto'},{ name: 'CheckHolderState', type: 'auto'},{ name: 'CheckHolderPhoneNumber', type: 'auto'},{ name: 'CheckHolderName', type: 'auto'},{ name: 'CheckHolderDriversLicense', type: 'auto'},{ name: 'CheckAccountType', type: 'auto'},{ name: 'CheckHolderCountry', type: 'auto'},{ name: 'EntityID', type: 'auto'}],data: [{IconCls:'newPaymentAccountCls',PaymentPlanID:'NEW',AccountNickname:'Add Credit/Debit Card',PaymentType:'CreditCard',IsDefaultPaymentMethod:'False',StartInEditMode:'False',IsEditable:'False',ShowAllFields:null,NameOnCard:null,CardNumber:null,CardHolderDriversLicense:null,ExpDate:null,ExpMonth:null,ExpYear:null,CardHolderAddress1:null,CardHolderAddress2:null,CardHolderCity:null,CardHolderState:null,CardHolderZip:null,CardHolderCountry:'US',CardHolderPhoneNumber:null,CVN:null,CheckHolderFirstName:null,CheckHolderLastName:null,RoutingNumber:null,AccountNumber:null,CheckHolderStreet1:null,CheckHolderStreet2:null,CheckHolderCity:null,CheckHolderZip:null,CheckHolderState:null,CheckHolderPhoneNumber:null,CheckHolderName:null,CheckHolderDriversLicense:null,CheckAccountType:null,CheckHolderCountry:null,EntityID:null},{IconCls:'echeckCls',PaymentPlanID:'NEW',AccountNickname:'Add Bank Account',PaymentType:'ECheck',IsDefaultPaymentMethod:'False',StartInEditMode:'False',IsEditable:'False',ShowAllFields:null,NameOnCard:null,CardNumber:null,CardHolderDriversLicense:null,ExpDate:null,ExpMonth:null,ExpYear:null,CardHolderAddress1:null,CardHolderAddress2:null,CardHolderCity:null,CardHolderState:null,CardHolderZip:null,CardHolderCountry:null,CardHolderPhoneNumber:null,CVN:null,CheckHolderFirstName:null,CheckHolderLastName:null,RoutingNumber:null,AccountNumber:null,CheckHolderStreet1:null,CheckHolderStreet2:null,CheckHolderCity:null,CheckHolderZip:null,CheckHolderState:null,CheckHolderPhoneNumber:null,CheckHolderName:null,CheckHolderDriversLicense:null,CheckAccountType:null,CheckHolderCountry:null,EntityID:null}]});function setAccountNicknameAndIcon(isNew) { var paymentType = InstaMed.getValue('AccountType'); var saveTheCardChkBox = InstaMed.get('SaveCardOnFile'); var iconName; if (paymentType == 'CreditCard' || (paymentType && paymentType.AccountType == 'CreditCard')) { var nickNameField = InstaMed.get('CardAccountNickName'); var nickNameLinkButton = Ext.getElementById('CardAccountNickNameLinkButton'); var cardNumber = InstaMed.getValue('CreditCardNumber'); if(cardNumber) { cardNumber = cardNumber.replace(/\D/g,''); var first = cardNumber.substr(0, 1); var firstTwo = cardNumber.substr(0, 2); var firstThree = cardNumber.substr(0, 3); var firstFour = cardNumber.substr(0, 4); var lastFour = cardNumber.substring(Math.max(cardNumber.length - 4, 0), cardNumber.length); var cardType; if(first == '4') { cardType = 'VISA'; iconName = 'PaymentIconVISA'; } else if(first == '5') { cardType = 'MasterCard'; iconName = 'PaymentIconMC'; } else if(firstTwo == '34' || firstTwo == '37') { cardType = 'AmEx'; iconName = 'PaymentIconAMEX'; } else if(firstFour == '6011' || firstTwo == '65') { cardType = 'Discover'; iconName = 'PaymentIconDISCOVER'; } else if(firstThree == '300' || firstThree == '305' || firstTwo == '36' || firstTwo == '38') { cardType = 'Diners'; } else if(first == '2') { var bin = cardNumber.length >= 6 ? parseInt(cardNumber.substr(0, 6)) : null; if (bin >= 222100 && bin <= 272099) { cardType = 'MasterCard'; iconName = 'PaymentIconMC'; } else { cardType = 'Card'; } } else { cardType = 'Card'; } if(saveTheCardChkBox) { var name =cardType + ' ****' + lastFour; nickNameField.setValue(name); nickNameLinkButton.textContent = name; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } if(nickNameField && InstaMed.isTrue(InstaMed.getValue('AutoGenerateNickname')) && InstaMed.isFalse(InstaMed.getValue('EditMode'))) { nickNameField.setValue(cardType + ' ****' + lastFour); if (nickNameLinkButton) { if(!isNew) { var name = cardType + ' ****' + lastFour; nickNameLinkButton.textContent = name; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } } } } if(!cardNumber && isNew) { if(nickNameField && InstaMed.isTrue(InstaMed.getValue('AutoGenerateNickname')) && InstaMed.isFalse(InstaMed.getValue('EditMode'))) { nickNameField.setValue(''); if (nickNameLinkButton) { nickNameLinkButton.textContent = ''; nickNameLinkButton.setAttribute('aria-label',''); } } } } else { iconName = 'PaymentIconECheck'; var accountNum = InstaMed.getValue('CheckingAccountNumber'); var nickNameField = InstaMed.get('CheckingAccountNickName'); var nickNameLinkButton = Ext.getElementById('CheckingAccountNickNameLinkButton'); if(accountNum) { var lastFour = accountNum.substring(Math.max(accountNum.length - 4, 0), accountNum.length); var checkingAccountType = 'Bank Account'; if(nickNameField && InstaMed.isTrue(InstaMed.getValue('AutoGenerateNickname')) && InstaMed.isFalse(InstaMed.getValue('EditMode'))) { nickNameField.setValue(checkingAccountType + ' ****' + lastFour); if (nickNameLinkButton) { if (isNew == true) { nickNameLinkButton.textContent = ''; nickNameLinkButton.setAttribute('aria-label',''); } else { var name = checkingAccountType + ' ****' + lastFour; nickNameLinkButton.textContent = name ; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } } } } if(!accountNum && isNew) { if(nickNameField && InstaMed.isTrue(InstaMed.getValue('AutoGenerateNickname')) && InstaMed.isFalse(InstaMed.getValue('EditMode'))) { nickNameField.setValue(''); if (nickNameLinkButton) { nickNameLinkButton.textContent = ''; nickNameLinkButton.setAttribute('aria-label',''); } } } } }Ext.define('MyApp.view.creditcardfield', { extend: 'Ext.field.Text', alias: 'widget.creditcardfield', getSubmitValue: function() { var val = Ext.field.Text.superclass.getValue.call(this); if(val) { val = val.replace(/[\-\s]/g,''); } return val; } });function HandleCVNDisplay(keyed) { var form = Ext.ComponentQuery.query('[name="FormPatientPayment"]')[0]; if(InstaMed.get('CVN',form)) { var val = InstaMed.get('CVNInitialState',form).getValue(); if(val) { var cvninitialstate = Ext.JSON.decode(val); var cvnfield = InstaMed.get('CVN',form); if(!cvninitialstate.manualCardReader) { if(!keyed) { cvnfield.setDisabled(cvninitialstate.disabled); cvnfield.setVisible(cvninitialstate.visible); } else { cvnfield.setDisabled(false); cvnfield.setVisible(cvninitialstate.formVisible); } } cvnfield.reset(); } } }Ext.create('Ext.data.ArrayStore',{ type: 'json', autoDestroy: false, storeId: 'CreditCardAccountHolderStateStore', fields: [ { name: 'code', type: 'string' }, { name: 'description', type: 'string' } ], data: [['AK', 'Alaska'],['AL', 'Alabama'],['AR', 'Arkansas'],['AZ', 'Arizona'],['CA', 'California'],['CO', 'Colorado'],['CT', 'Connecticut'],['DC', 'District Of Columbia'],['DE', 'Delaware'],['FL', 'Florida'],['GA', 'Georgia'],['HI', 'Hawaii'],['IA', 'Iowa'],['ID', 'Idaho'],['IL', 'Illinois'],['IN', 'Indiana'],['KS', 'Kansas'],['KY', 'Kentucky'],['LA', 'Louisiana'],['MA', 'Massachusetts'],['MD', 'Maryland'],['ME', 'Maine'],['MI', 'Michigan'],['MN', 'Minnesota'],['MO', 'Missouri'],['MS', 'Mississippi'],['MT', 'Montana'],['NC', 'North Carolina'],['ND', 'North Dakota'],['NE', 'Nebraska'],['NH', 'New Hampshire'],['NJ', 'New Jersey'],['NM', 'New Mexico'],['NV', 'Nevada'],['NY', 'New York'],['OH', 'Ohio'],['OK', 'Oklahoma'],['OR', 'Oregon'],['PA', 'Pennsylvania'],['RI', 'Rhode Island'],['SC', 'South Carolina'],['SD', 'South Dakota'],['TN', 'Tennessee'],['TX', 'Texas'],['UT', 'Utah'],['VA', 'Virginia'],['VT', 'Vermont'],['WA', 'Washington'],['WI', 'Wisconsin'],['WV', 'West Virginia'],['WY', 'Wyoming'] ]})Ext.create('Ext.data.ArrayStore',{ type: 'json', autoDestroy: false, storeId: 'CheckingAccountHolderStateStore', fields: [ { name: 'code', type: 'string' }, { name: 'description', type: 'string' } ], data: [['AK', 'Alaska'],['AL', 'Alabama'],['AR', 'Arkansas'],['AS', 'American Samoa'],['AZ', 'Arizona'],['CA', 'California'],['CO', 'Colorado'],['CT', 'Connecticut'],['DC', 'District Of Columbia'],['DE', 'Delaware'],['FL', 'Florida'],['FM', 'Federated States Of Micronesia'],['GA', 'Georgia'],['GU', 'Guam'],['HI', 'Hawaii'],['IA', 'Iowa'],['ID', 'Idaho'],['IL', 'Illinois'],['IN', 'Indiana'],['KS', 'Kansas'],['KY', 'Kentucky'],['LA', 'Louisiana'],['MA', 'Massachusetts'],['MD', 'Maryland'],['ME', 'Maine'],['MH', 'Marshall Islands'],['MI', 'Michigan'],['MN', 'Minnesota'],['MO', 'Missouri'],['MP', 'Northern Mariana Islands'],['MS', 'Mississippi'],['MT', 'Montana'],['NC', 'North Carolina'],['ND', 'North Dakota'],['NE', 'Nebraska'],['NH', 'New Hampshire'],['NJ', 'New Jersey'],['NM', 'New Mexico'],['NV', 'Nevada'],['NY', 'New York'],['OH', 'Ohio'],['OK', 'Oklahoma'],['OR', 'Oregon'],['PA', 'Pennsylvania'],['PR', 'Puerto Rico'],['PW', 'Palau'],['RI', 'Rhode Island'],['SC', 'South Carolina'],['SD', 'South Dakota'],['TN', 'Tennessee'],['TX', 'Texas'],['UT', 'Utah'],['VA', 'Virginia'],['VI', 'Virgin Islands'],['VT', 'Vermont'],['WA', 'Washington'],['WI', 'Wisconsin'],['WV', 'West Virginia'],['WY', 'Wyoming'] ]}) var applePayJSFuncs = { isApplePaySupported : function() { if (window.ApplePaySession && ApplePaySession.canMakePayments()) { return true; } return false; }, getFormData: function(form, payment) { var formData = form.getValues(); formData.MobilePayTokenData = encodeURIComponent(JSON.stringify(payment.token.paymentData)); formData.MobilePayCardHolderFirstName = applePayJSFuncs.getFirstName(payment); formData.MobilePayCardHolderLastName = applePayJSFuncs.getLastName(payment); formData.MobilePayCardHolderAddress1 = applePayJSFuncs.getAddress1(payment); formData.MobilePayCardHolderAddress2 = applePayJSFuncs.getAddress2(payment); formData.MobilePayCardHolderCity = applePayJSFuncs.getCity(payment); formData.MobilePayCardHolderState = applePayJSFuncs.getState(payment); formData.MobilePayCardHolderZip = applePayJSFuncs.getZip(payment); formData.MobilePayCardHolderCountry = applePayJSFuncs.getCountry(payment); return formData; }, getAddress1: function(payment) { if (payment.billingContact.addressLines.length > 0) { return payment.billingContact.addressLines[0]; } return ''; }, getAddress2: function(payment) { if (payment.billingContact.addressLines.length > 1) { return payment.billingContact.addressLines[1]; } return ''; }, getFirstName: function(payment) { return payment.billingContact.givenName; }, getLastName: function(payment) { return payment.billingContact.familyName; }, getCity: function(payment) { return payment.billingContact.locality; }, getState: function(payment) { return payment.billingContact.administrativeArea; }, getZip: function(payment) { return payment.billingContact.postalCode; }, getCountry: function(payment) { return payment.billingContact.countryCode; }, getMerchantCapabilities: function() { return ['supports3DS', 'supportsDebit', 'supportsCredit']; }, processApplePay : function(cmp, data, afterPaymentAuthorized) { var cmpForm = InstaMed.getParentForm(cmp); InstaMed.clearValidation(cmpForm); if(!data.amount || data.amount <= 0) { InstaMed.displayJSValidationErrors(cmpForm, ['Amount Required']); return; } var request = { countryCode: 'US', currencyCode: 'USD', supportedNetworks: data.supportedPaymentMethods, merchantCapabilities: applePayJSFuncs.getMerchantCapabilities(), requiredBillingContactFields: [ 'name', 'postalAddress' ], total: { label: data.payeeName, amount: data.amount } }; var appleSession = new ApplePaySession(1, request); appleSession.onvalidatemerchant = function(event) { var merchantSessionData = new Object(); merchantSessionData.Amount = data.amount; PerformAction(merchantSessionData, MobilePayController.getApplePayMerchantSession, cmp, applePayJSFuncs.onMerchantSessionSuccess, appleSession, false, applePayJSFuncs.onMerchantSessionFailure, appleSession); } appleSession.onpaymentauthorized = function(event) { afterPaymentAuthorized(cmp, appleSession, event.payment); } appleSession.begin(); }, onMerchantSessionSuccess : function(cmp, response, appleSession) { if(appleSession && response && response.additionalData) { try { appleSession.completeMerchantValidation(response.additionalData); } catch (err) { //Exception can be thrown if the session is already timed-out or cancelled by the user } } }, onMerchantSessionFailure : function(cmp, response, appleSession) { if(appleSession) { try { appleSession.abort(); } catch (err) { //Exception can be thrown if the session is already timed-out or cancelled by the user } } }, afterPaymentSuccess: function(cmp, response, data) { if(response && data) { if(response.additionalData && response.additionalData.isPaymentApproved) { applePayJSFuncs.completeApplePay(data, ApplePaySession.STATUS_SUCCESS); } else { applePayJSFuncs.completeApplePay(data, ApplePaySession.STATUS_FAILURE); } if(data.closeWindow) { window.close(); } } else { applePayJSFuncs.afterPaymentFailure(cmp, response, data); } }, afterPaymentFailure: function(cmp, response, data) { applePayJSFuncs.completeApplePay(data, ApplePaySession.STATUS_FAILURE); }, completeApplePay: function(data, status) { if(data && data.appleSession) { try { data.appleSession.completePayment(status); } catch(err) { //Exception can be thrown if the session is already timed-out } } } }; var googlePayJSFuncs = { getFormData: function(form, paymentData) { var formData = form.getValues(); formData.MobilePayTokenData = encodeURIComponent(paymentData.paymentMethodData.tokenizationData.token); formData.MobilePayCardHolderName = googlePayJSFuncs.getName(paymentData); formData.MobilePayCardHolderAddress1 = googlePayJSFuncs.getAddress1(paymentData); formData.MobilePayCardHolderAddress2 = googlePayJSFuncs.getAddress2(paymentData); formData.MobilePayCardHolderCity = googlePayJSFuncs.getCity(paymentData); formData.MobilePayCardHolderState = googlePayJSFuncs.getState(paymentData); formData.MobilePayCardHolderZip = googlePayJSFuncs.getZip(paymentData); formData.MobilePayCardHolderCountry = googlePayJSFuncs.getCountry(paymentData); return formData; }, getBaseRequest: function() { return { apiVersion: 2, apiVersionMinor: 0 }; }, getAllowedCardAuthMethods: function() { return ['PAN_ONLY', 'CRYPTOGRAM_3DS']; }, getTokenizationSpecification: function() { return { type: 'PAYMENT_GATEWAY', parameters: { 'gateway': 'instamed', 'gatewayMerchantId': '0637000000757816-0001-0002' } }; }, getBaseCardPaymentMethod: function(allowedCardNetworks) { return { type: 'CARD', parameters: { allowedAuthMethods: this.getAllowedCardAuthMethods(), allowedCardNetworks: allowedCardNetworks, billingAddressRequired: true, billingAddressParameters: {'format': 'FULL'}, allowCreditCards: true } }; }, getCardPaymentMethod: function(allowedCardNetworks) { return Object.assign( { tokenizationSpecification : this.getTokenizationSpecification() }, this.getBaseCardPaymentMethod(allowedCardNetworks) ); }, getGooglePaymentDataRequest: function(data) { var paymentDataRequest = this.getBaseRequest(); paymentDataRequest.allowedPaymentMethods = [this.getCardPaymentMethod(data.supportedPaymentMethods)]; paymentDataRequest.merchantInfo = { merchantName: data.payeeName, merchantId: 'BCR2DN6TV736PG3W' }; paymentDataRequest.callbackIntents = ['PAYMENT_AUTHORIZATION']; return paymentDataRequest; }, getGooglePaymentsClient: function(afterPaymentAuthorized, cmp) { return new google.payments.api.PaymentsClient({environment: 'PRODUCTION', paymentDataCallbacks: { onPaymentAuthorized: function(paymentData) { return new Promise(function(resolve, reject) { afterPaymentAuthorized(cmp, paymentData, resolve); }); } } }); }, processGooglePay : function(cmp, data, afterPaymentAuthorized) { var cmpForm = InstaMed.getParentForm(cmp); InstaMed.clearValidation(cmpForm); if(!data.amount || data.amount <= 0) { InstaMed.displayJSValidationErrors(cmpForm, ['Amount Required']); return; } var paymentDataRequest = googlePayJSFuncs.getGooglePaymentDataRequest(data); paymentDataRequest.transactionInfo = googlePayJSFuncs.getGoogleTransactionInfo(data); var paymentsClient = googlePayJSFuncs.getGooglePaymentsClient(afterPaymentAuthorized, cmp); paymentsClient.loadPaymentData(paymentDataRequest); }, checkGooglePaySupport: function(data, afterSuccess) { try { var paymentsClient = this.getGooglePaymentsClient(); var paymentDataRequest = this.getBaseRequest(); paymentDataRequest.allowedPaymentMethods = [this.getBaseCardPaymentMethod(data.supportedPaymentMethods)]; paymentsClient.isReadyToPay(paymentDataRequest) .then(function(response) { if (response.result) { afterSuccess(); } }) .catch(function(err) { window.console && window.console.log && window.console.log(err); }); } catch(err) { window.console && window.console.log && window.console.log(err); } }, getGoogleTransactionInfo: function(data) { return { countryCode: 'US', currencyCode: 'USD', totalPriceStatus: 'FINAL', totalPrice: data.amount }; }, getName: function(paymentData) { return paymentData.paymentMethodData.info.billingAddress.name; }, getAddress1: function(paymentData) { return paymentData.paymentMethodData.info.billingAddress.address1; }, getAddress2: function(paymentData) { return paymentData.paymentMethodData.info.billingAddress.address2; }, getCity: function(paymentData) { return paymentData.paymentMethodData.info.billingAddress.locality; }, getState: function(paymentData) { return paymentData.paymentMethodData.info.billingAddress.administrativeArea; }, getZip: function(paymentData) { return paymentData.paymentMethodData.info.billingAddress.postalCode; }, getCountry: function(paymentData) { return paymentData.paymentMethodData.info.billingAddress.countryCode; }, afterPaymentSuccess: function(cmp, response, data) { if(response && data) { if(response.additionalData && response.additionalData.isPaymentApproved) { googlePayJSFuncs.completeGooglePay(data, {transactionState: 'SUCCESS'}); } else { googlePayJSFuncs.completeGooglePay(data, { transactionState: 'ERROR', error: { intent: 'PAYMENT_AUTHORIZATION', message: 'Payment Declined.', reason: 'PAYMENT_DATA_INVALID' } }); } if(data.closeWindow) { window.close(); } } else { googlePayJSFuncs.afterPaymentFailure(cmp, response, data); } }, afterPaymentFailure: function(cmp, response, data) { googlePayJSFuncs.completeGooglePay(data, { transactionState: 'ERROR', error: { intent: 'PAYMENT_AUTHORIZATION', message: 'Could not complete the payment.', reason: 'PAYMENT_DATA_INVALID' } }); }, completeGooglePay: function(data, result) { if(data && data.onGooglePayComplete && result) { try { data.onGooglePayComplete(result); } catch(err) { //Exception can be thrown if the session is already timed-out } } } } Ext.define('MyApp.model.CodeDescriptionPaymentInformationReviewAndConfirmStore',{extend: 'Ext.data.Model',id: 'PaymentInformationReviewAndConfirmStore',fields: [{name:'Index'},{name:'Duration'},{name:'InstallmentAmount'},{name:'InstallmentAmountDescription'},{name:'StartDate'},{name:'EndDate'},{name:'Frequency'},{name:'FrequencyDescription'},{name:'TotalPlanAmount'},{name:'IsRecommended'},{name:'IsSelected'},{name:'IsCustomPlan'},{name:'InitialPayment'},{name:'FrequncyTranslate'}]});Ext.create('Ext.data.JsonStore',{ autoDestroy: false, proxy: { type: 'memory', reader: 'json', writer: 'json' }, storeId: 'PaymentInformationReviewAndConfirmStore', fields: [{ name: 'Index', type: 'auto'},{ name: 'Duration', type: 'auto'},{ name: 'InstallmentAmount', type: 'auto'},{ name: 'InstallmentAmountDescription', type: 'auto'},{ name: 'StartDate', type: 'auto'},{ name: 'EndDate', type: 'auto'},{ name: 'Frequency', type: 'auto'},{ name: 'FrequencyDescription', type: 'auto'},{ name: 'TotalPlanAmount', type: 'auto'},{ name: 'IsRecommended', type: 'auto'},{ name: 'IsSelected', type: 'auto'},{ name: 'IsCustomPlan', type: 'auto'},{ name: 'InitialPayment', type: 'auto'},{ name: 'FrequncyTranslate', type: 'auto'}],data: []});Ext.define('PatientPaymentConfirmMultiARDataViewModel', { extend: 'Ext.data.Model', config: { fields: [ { name: 'PaymentDate' },{ name: 'Amount' },{ name: 'PatientID' },{ name: 'PatientMedicalRecordNumber' },{ name: 'PatientFirstName' },{ name: 'PatientMiddleName' },{ name: 'PatientLastName' },{ name: 'PatientBirthDate' },{ name: 'PatientPhoneNumber' },{ name: 'AccountHolderEmail' },{ name: 'PatientInvoiceNumber' },{ name: 'PatientServiceBeginDate' },{ name: 'PatientServiceEndDate' },{ name: 'PatientAddress1' },{ name: 'PatientAddress2' },{ name: 'PatientCity' },{ name: 'PatientState' },{ name: 'PatientZip' },{ name: 'PatientCountry' },{ name: 'TransactionCode' },{ name: 'AdditionalCode1' },{ name: 'AdditionalCode2' },{ name: 'AdditionalCode3' },{ name: 'AdditionalCode4' },{ name: 'AdditionalCode5' },{ name: 'AdditionalCode6' },{ name: 'AdditionalInfo1' },{ name: 'AdditionalInfo2' },{ name: 'AdditionalInfo3' },{ name: 'AdditionalInfo4' },{ name: 'AdditionalInfo5' },{ name: 'AdditionalInfo6' },{ name: 'LineItemKey' } ] } }); Ext.create('Ext.data.Store', { id:'PatientPaymentConfirmMultiARDataViewstore', model: 'PatientPaymentConfirmMultiARDataViewModel', autoLoad: true, proxy: { type: 'memory', reader: { type: 'json' }, data: [] } });function NavigateToPatientInformation(lineItemKey) { var form = InstaMed.getNavigationView(); form.push('NavPatientInformation'); if(lineItemKey) { editLineItem(lineItemKey); } PerformAction({}, PatientPaymentController.editPatientInformation); }function NavigateToQuickPayPatientEntry(lineItemKey) { var form = InstaMed.getNavigationView(); form.push('NavQuickPayPatientEntry'); if(lineItemKey) { editLineItem(lineItemKey); } javascript: PerformAction({}, QuickPayPatientEntryController.editPatientInformation,null); return false; }function NavigateToPaymentInformation() { var form = InstaMed.getNavigationView(); var prevFormData = form.getLastFormObject(); form.push('NavQuickPayPaymentInformation'); form.setLastFormObject(prevFormData); }function wrongCaptcha() { grecaptcha.reset(); }Ext.define('Ext.InstaMed.FormPanel',{extend: 'Ext.form.Panel',alias: 'widget.form',config: { defaultSubmitButton: null }});function NavigateToProviderInformation() { PerformAction({}, PatientPaymentController.editProviderInformation); }function NavigateToPatientInformation(lineItemKey) { var form = InstaMed.getNavigationView(); form.push('NavPatientInformation'); if(lineItemKey) { editLineItem(lineItemKey); } PerformAction({}, PatientPaymentController.editPatientInformation); }function NavigateToQuickPayPatientEntry(lineItemKey) { var form = InstaMed.getNavigationView(); form.push('NavQuickPayPatientEntry'); if(lineItemKey) { editLineItem(lineItemKey); } javascript: PerformAction({}, QuickPayPatientEntryController.editPatientInformation,null); return false; }function NavigateToPaymentInformation() { var form = InstaMed.getNavigationView(); var prevFormData = form.getLastFormObject(); form.push('NavPaymentInformation'); form.setLastFormObject(prevFormData); }function setPositionOnResize(){ var cmp = InstaMed.get('HealthcareBillPaymentAd'); if(cmp && cmp.isVisible()) { cmp.center(); } }function setPositionOnResizeWithDelay() { setTimeout(setPositionOnResize, 200)}Ext.define('MyApp.model.CodeDescriptionPaymentPlanPaymentsBreakdownStore',{extend: 'Ext.data.Model',id: 'PaymentPlanPaymentsBreakdownStore',fields: [{name:'Description'},{name:'Amount'},{name:'IsTotalAmount'}]});Ext.create('Ext.data.JsonStore',{ autoDestroy: false, proxy: { type: 'memory', reader: 'json', writer: 'json' }, storeId: 'PaymentPlanPaymentsBreakdownStore', fields: [{ name: 'Description', type: 'auto'},{ name: 'Amount', type: 'auto'},{ name: 'IsTotalAmount', type: 'auto'}],data: []});InstaMed.pages = new Array();Ext.Date.monthNames = [ 'January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December']Ext.Date.dayNames = [ 'Sunday', 'Monday', 'Tuesday', 'Wednesday', 'Thursday', 'Friday', 'Saturday']InstaMed.pages.push('NavFindAndSearch');InstaMed.pages.push('NavQuickPayPatientEntry');InstaMed.pages.push('NavQuickPayAccountSummary');InstaMed.pages.push('NavSelectProvider');InstaMed.pages.push('APCAboutWindow');InstaMed.pages.push('NavReceiptPreview');InstaMed.pages.push('ShareReceiptWindow');InstaMed.pages.push('NavAPCTerms');InstaMed.pages.push('PaymentPlanPaymentsBreakdownWindow');InstaMed.pages.push('EStatementEnrollmentInfo');InstaMed.pages.push('EStatementEnrollmentInfo');InstaMed.pages.push('EditMobilePhoneWindow');InstaMed.pages.push('NavPageIdleTimeoutForm');InstaMed.PageMaximumSequenceNumber=68; InstaMed.PopulatePaymentPlanPaymentsBreakdownDataViewComponentFromPaymentOptionDataViewComponent = function(storeIndex){ var store = InstaMed.get("PaymentOptionDataViewComponent").getStore(); var dataObj; if(storeIndex !== null){ dataObj = store.getAt(storeIndex-1); } else { if(store.queryRecords("IsSelected",true).length>0){ dataObj = store.queryRecords("IsSelected",true)[0]; }else{ dataObj = store.getAt(0); } } PerformAction({ Duration: dataObj.get("Duration"), EndDate: dataObj.get("EndDate"), Frequency: dataObj.get("Frequency"), InstallmentAmount: dataObj.get("InstallmentAmount"), IsRecommended: dataObj.get("IsRecommended"), IsSelected: dataObj.get("IsSelected"), StartDate: dataObj.get("StartDate"), TotalPlanAmount: dataObj.get("TotalPlanAmount").substr(1), InitialAmount: dataObj.get("InitialPayment").substr(1), }, PaymentOptionsController.getPaymentPlanPaymentsBreakdownWindowDetails ); }; InstaMed.PopulatePaymentPlanPaymentsBreakdownDataViewComponentFromPaymentInformationDataView = function(storeIndex){ var store = InstaMed.get("PaymentInformationDataView").getStore(); var dataObj; if(storeIndex !== null){ dataObj = store.getAt(storeIndex-1); } else { if(store.queryRecords("IsSelected",true).length>0){ dataObj = store.queryRecords("IsSelected",true)[0]; }else{ dataObj = store.getAt(0); } } PerformAction({ Duration: dataObj.get("Duration"), EndDate: dataObj.get("EndDate"), Frequency: dataObj.get("Frequency"), InstallmentAmount: dataObj.get("InstallmentAmount"), IsRecommended: dataObj.get("IsRecommended"), IsSelected: dataObj.get("IsSelected"), StartDate: dataObj.get("StartDate"), TotalPlanAmount: dataObj.get("TotalPlanAmount").substr(1), InitialAmount: dataObj.get("InitialPayment").substr(1), }, PaymentOptionsController.getPaymentPlanPaymentsBreakdownWindowDetails ); };function setCardTypeIconCLS() { var cardType = InstaMed.get('CardType'); var creditCardField = InstaMed.get('CreditCardNumber'); if(cardType && creditCardField) { var triggers = creditCardField.getTriggers(); if (triggers && triggers.VISATrigger) { creditCardField.removeTrigger('VISATrigger'); } if (triggers && triggers.AmexTrigger) { creditCardField.removeTrigger('AmexTrigger'); } if (triggers && triggers.DiscoveryTrigger) { creditCardField.removeTrigger('DiscoveryTrigger'); } if (triggers && triggers.MasterCardTrigger) { creditCardField.removeTrigger('MasterCardTrigger'); } if (triggers && triggers.OtherCardsTrigger) { creditCardField.removeTrigger('OtherCardsTrigger'); } if(InstaMed.isTrue('False')){ cardType.setValue(''); } var cardTypeValue = cardType.getValue(); if(cardTypeValue) { cardTypeValue = cardTypeValue.toUpperCase(); if(cardTypeValue != 'INITIAL') { if(cardTypeValue == 'MC') { if (triggers && !triggers.MasterCardTrigger) { creditCardField.addTrigger('MasterCardTrigger',{cls:'mastercardCls',type: 'cardIcon'}); } } else if(cardTypeValue == 'VISA') { if (triggers && !triggers.VISATrigger) { creditCardField.addTrigger('VISATrigger',{cls:'visaCls',type: 'cardIcon'}); } } else if(cardTypeValue == 'AMEX') { if (triggers && !triggers.AmexTrigger) { creditCardField.addTrigger('AmexTrigger',{cls:'amexCls',type: 'cardIcon'}); } } else if(cardTypeValue == 'DISCOVER') { if (triggers && !triggers.DiscoveryTrigger) { creditCardField.addTrigger('DiscoveryTrigger',{cls:'discoverCls',type: 'cardIcon'}); } } else if(cardTypeValue == 'OTHER') { if (triggers && !triggers.OtherCardsTrigger) { creditCardField.addTrigger('OtherCardsTrigger',{cls:'echeckCls',type: 'cardIcon'}); } } } } else { if (triggers && !triggers.VISATrigger && true) { creditCardField.addTrigger('VISATrigger',{cls:'visaCls',type: 'cardIcon'}); } if (triggers && !triggers.DiscoveryTrigger && true) { creditCardField.addTrigger('DiscoveryTrigger',{cls:'discoverCls',type: 'cardIcon'}); } if (triggers && !triggers.MasterCardTrigger && true) { creditCardField.addTrigger('MasterCardTrigger',{cls:'mastercardCls',type: 'cardIcon'}); } if (triggers && !triggers.AmexTrigger && true) { creditCardField.addTrigger('AmexTrigger',{cls:'amexCls',type: 'cardIcon'}); } if (triggers && !triggers.OtherCardsTrigger && false) { creditCardField.addTrigger('OtherCardsTrigger',{cls:'echeckCls',type: 'cardIcon'}); } } } }function handleNickName(promptMessageValue) { var maxLength = 100; if (window.message) { var promptObj = window.message.getPrompt(); promptObj.setValue(promptMessageValue); window.message.show(); } else { Ext.Msg.setStandardButtons({ ok: { text: 'Ok', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 120 : 10 }, abort: { text: 'Abort', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 110 : 20 }, retry: { text: 'Retry', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 100 : 30 }, ignore: { text: 'Ignore', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 90 : 40 }, yes: { text: 'Yes', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 80 : 50 }, no: { text: 'No', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 70 : 60 }, cancel: { text: 'Cancel', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 60 : 70 }, apply: { text: 'Apply', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 50 : 80 }, save: { text: 'Save', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 40 : 90 }, submit: { text: 'Submit', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 30 : 100 }, help: { text: 'Help', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 10 : 110 }, close: { text: 'Close', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 20 : 120 }}); window.message = Ext.Msg.prompt('Add Nickname', 'Nickname', function (btn, value) { if(btn == 'ok') { setNickName(value)} },null,false,promptMessageValue,this); if (typeof(maxLength) == 'number') { var promptObj = window.message.getPrompt(); promptObj.setMaxLength(maxLength); promptObj.setInputAttribute('aria-label','Nickname'); promptObj.setInputAttribute('aria-required',true); } } }function setNickName(name) { if (!Ext.isEmpty(name)) { var accountType; var accountTypeCmp = InstaMed.get('AccountType'); if (accountTypeCmp) { accountType = accountTypeCmp.getValue(); } if (accountType == 'CreditCard') { var nickNameField = InstaMed.get('CardAccountNickName'); var nickNameLinkButton = Ext.getElementById('CardAccountNickNameLinkButton'); if (nickNameField) { nickNameField.setValue(name); nickNameLinkButton.textContent = name; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } } else if (accountType == 'ECheck') { var nickNameField = InstaMed.get('CheckingAccountNickName'); var nickNameLinkButton = Ext.getElementById('CheckingAccountNickNameLinkButton'); if (nickNameField) { nickNameField.setValue(name); nickNameLinkButton.textContent = name; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } } else { var nickNameField = InstaMed.get('BlindPaymentAccountNickName'); var nickNameLinkButton = Ext.getElementById('BlindPaymentAccountNickNameLinkButton'); if(nickNameField) { nickNameField.setValue(name); nickNameLinkButton.textContent = name; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } } } } function setBlindPaymentNickName(value) { var nickNameLinkButton = Ext.getElementById('BlindPaymentAccountNickNameLinkButton'); if (nickNameLinkButton) { nickNameLinkButton.textContent = value; } } function apcVisibility(prefix, checkboxName){ var APcontrol = InstaMed.get('AutomaticPaymentContainer'); var APcheckbox = InstaMed.get('EnrollAutomaticPayment'); var APAuth = InstaMed.getValue('IsPatientAuthenticated'); var paymentMethodDisclaimer = InstaMed.get('prefixSavePaymentMethodDislaimer'); var whatIsAPC = document.getElementById('WhatIsAPC'); if(APcontrol !=null && APcheckbox!=null){ if(InstaMed.get(checkboxName)){ if(InstaMed.get(checkboxName).getChecked()) { if(APAuth == true) { APcontrol.show(); APcheckbox.enable(); APcontrol.removeCls('im-apc-container-disabled'); whatIsAPC && whatIsAPC.setAttribute('tabIndex','0'); APcheckbox.ariaEl.dom.tabIndex=0; } else { APcontrol.hide(); APcheckbox.setChecked && APcheckbox.setChecked(false); APcheckbox.setValue && APcheckbox.setValue(false); } if (paymentMethodDisclaimer) { paymentMethodDisclaimer.hide(); } } else { APcheckbox.disable(); APcontrol.addCls('im-apc-container-disabled'); whatIsAPC && whatIsAPC.setAttribute('tabIndex','-1'); APcheckbox.ariaEl.dom.tabIndex=-1; APcheckbox.setChecked && APcheckbox.setChecked(false); APcheckbox.setValue && APcheckbox.setValue(false); if (paymentMethodDisclaimer) { paymentMethodDisclaimer.show(); } } } } }function handleNickName(promptMessageValue) { var maxLength = 100; if (window.message) { var promptObj = window.message.getPrompt(); promptObj.setValue(promptMessageValue); window.message.show(); } else { Ext.Msg.setStandardButtons({ ok: { text: 'Ok', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 120 : 10 }, abort: { text: 'Abort', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 110 : 20 }, retry: { text: 'Retry', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 100 : 30 }, ignore: { text: 'Ignore', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 90 : 40 }, yes: { text: 'Yes', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 80 : 50 }, no: { text: 'No', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 70 : 60 }, cancel: { text: 'Cancel', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 60 : 70 }, apply: { text: 'Apply', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 50 : 80 }, save: { text: 'Save', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 40 : 90 }, submit: { text: 'Submit', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 30 : 100 }, help: { text: 'Help', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 10 : 110 }, close: { text: 'Close', weight: Ext.platformTags.ios || Ext.platformTags.mac ? 20 : 120 }}); window.message = Ext.Msg.prompt('Add Nickname', 'Nickname', function (btn, value) { if(btn == 'ok') { setNickName(value)} },null,false,promptMessageValue,this); if (typeof(maxLength) == 'number') { var promptObj = window.message.getPrompt(); promptObj.setMaxLength(maxLength); promptObj.setInputAttribute('aria-label','Nickname'); promptObj.setInputAttribute('aria-required',true); } } }function setNickName(name) { if (!Ext.isEmpty(name)) { var accountType; var accountTypeCmp = InstaMed.get('AccountType'); if (accountTypeCmp) { accountType = accountTypeCmp.getValue(); } if (accountType == 'CreditCard') { var nickNameField = InstaMed.get('CardAccountNickName'); var nickNameLinkButton = Ext.getElementById('CardAccountNickNameLinkButton'); if (nickNameField) { nickNameField.setValue(name); nickNameLinkButton.textContent = name; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } } else if (accountType == 'ECheck') { var nickNameField = InstaMed.get('CheckingAccountNickName'); var nickNameLinkButton = Ext.getElementById('CheckingAccountNickNameLinkButton'); if (nickNameField) { nickNameField.setValue(name); nickNameLinkButton.textContent = name; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } } else { var nickNameField = InstaMed.get('BlindPaymentAccountNickName'); var nickNameLinkButton = Ext.getElementById('BlindPaymentAccountNickNameLinkButton'); if(nickNameField) { nickNameField.setValue(name); nickNameLinkButton.textContent = name; nickNameLinkButton.setAttribute('aria-label','Edit '+name+' nickname'); } } } } function setBlindPaymentNickName(value) { var nickNameLinkButton = Ext.getElementById('BlindPaymentAccountNickNameLinkButton'); if (nickNameLinkButton) { nickNameLinkButton.textContent = value; } } function apcVisibility(prefix, checkboxName){ var APcontrol = InstaMed.get('AutomaticPaymentContainer'); var APcheckbox = InstaMed.get('EnrollAutomaticPayment'); var APAuth = InstaMed.getValue('IsPatientAuthenticated'); var paymentMethodDisclaimer = InstaMed.get('prefixSavePaymentMethodDislaimer'); var whatIsAPC = document.getElementById('WhatIsAPC'); if(APcontrol !=null && APcheckbox!=null){ if(InstaMed.get(checkboxName)){ if(InstaMed.get(checkboxName).getChecked()) { if(APAuth == true) { APcontrol.show(); APcheckbox.enable(); APcontrol.removeCls('im-apc-container-disabled'); whatIsAPC && whatIsAPC.setAttribute('tabIndex','0'); APcheckbox.ariaEl.dom.tabIndex=0; } else { APcontrol.hide(); APcheckbox.setChecked && APcheckbox.setChecked(false); APcheckbox.setValue && APcheckbox.setValue(false); } if (paymentMethodDisclaimer) { paymentMethodDisclaimer.hide(); } } else { APcheckbox.disable(); APcontrol.addCls('im-apc-container-disabled'); whatIsAPC && whatIsAPC.setAttribute('tabIndex','-1'); APcheckbox.ariaEl.dom.tabIndex=-1; APcheckbox.setChecked && APcheckbox.setChecked(false); APcheckbox.setValue && APcheckbox.setValue(false); if (paymentMethodDisclaimer) { paymentMethodDisclaimer.show(); } } } } } InstaMed.PopulatePaymentPlanPaymentsBreakdownDataViewComponentFromPaymentInformationReviewAndConfirmDataView = function(storeIndex){ var store = InstaMed.get("PaymentInformationReviewAndConfirmDataView").getStore(); var dataObj; if(storeIndex !== null){ dataObj = store.getAt(storeIndex-1); } else { if(store.queryRecords("IsSelected",true).length>0){ dataObj = store.queryRecords("IsSelected",true)[0]; }else{ dataObj = store.getAt(0); } } PerformAction({ Duration: dataObj.get("Duration"), EndDate: dataObj.get("EndDate"), Frequency: dataObj.get("Frequency"), InstallmentAmount: dataObj.get("InstallmentAmount"), IsRecommended: dataObj.get("IsRecommended"), IsSelected: dataObj.get("IsSelected"), StartDate: dataObj.get("StartDate"), TotalPlanAmount: dataObj.get("TotalPlanAmount").substr(1), InitialAmount: dataObj.get("InitialPayment").substr(1), }, PaymentOptionsController.getPaymentPlanPaymentsBreakdownWindowDetails ); };Ext.define('MyApp.view.NavigationView',{extend: 'InstaMed.navigation.View',alias: 'widget.mynavigationview',config: { name: 'NavigationView', useLogo: true, configInnerStates:[0], configActiveItem:0, configLastForm:[new Object()], mobilePrimaryActionButtonInTitleBar: false, mobileSecondaryActionButtonInTitleBar: false, navigationBar: false, items: [ {xtype: 'container', name: 'NavFindAndSearch', layout: {type: 'vbox', pack: 'start'}, showBackButton: true, scrollable: 'true', id: 'NavFindAndSearch', items: [ {xtype: 'container', docked: 'top', scrollable: null, id: 'NavFindAndSearch_container', items: [ {xtype: 'instamedNavigationBar', name: 'headerBar', layout: {type: 'hbox'}, hidden: false, cls: 'im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavFindAndSearch_headerBar', items: [ {xtype: 'spacer', id: 'NavFindAndSearch_spacer', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'titlebar', maxWidth: 1272, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavFindAndSearch_titlebar', plugins: 'responsive', responsiveConfig: {'width >= 1272':{title :'',},'width < 1272':{title : ' ',},}, items: [ {xtype: 'button', accessibleText: 'Back', iconCls: 'x-ma ma-arrow-back', align: 'left', name: 'TitleBarNavigationViewBack', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-icon-link-style white hiddenlg noprint', id: 'NavFindAndSearch_TitleBarNavigationViewBack', plugins: 'responsive', responsiveConfig: {'width > 1272':{iconCls :'',},'width <= 1272':{iconCls : 'x-ma ma-arrow-back',},}, listeners: {tap: function(){ headerPatientPortalBack(); }} }, {xtype: 'image', width: 127, height: 40, src: 'https://instamedprd.cachefly.net/V_2022_August/Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry', align: 'left', cls: 'x-clickable x-image-size-contain', id: 'NavFindAndSearch_image', plugins: 'responsive', responsiveConfig: {'width >= 1272':{hidden : false,},'width < 1272':{hidden :true,},}, listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Start'; }} }, {xtype: 'button', name: 'HeaderTitlebarButton', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style im-center-header-button white noprint', id: 'NavFindAndSearch_HeaderTitlebarButton' }, {xtype: 'button', text: 'Pay Any Healthcare Bill', align: 'right', name: 'PayAnyHealthcareBillButton', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style x-border hiddenxs hiddensm white noprint', id: 'NavFindAndSearch_button_PayAnyHealthcareBill', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?id=foxhallpodiatry&pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', text: 'Pay Bills', iconCls: 'x-ma ma-search', iconAlign: 'top', align: 'right', name: 'PayAnyHealthcareBillIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-ontop-link-style white hiddenmd hiddenlg noprint', id: 'NavFindAndSearch_button_PayBills', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', accessibleText: 'Log In or Sign Up', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Log In', handler: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }, id: 'menuitem_LogIn'},{xtype: 'menuitem', text: 'Sign Up', handler: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }, id: 'menuitem_SignUp'},], name: 'LoginOrSignUpProfileIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavFindAndSearch_button_LoginOrSignUpProfileIcon', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: true,},'!InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=LoginOrSignUpProfileIcon]')[0].getMenu().hide(); }} }, {xtype: 'button', text: '', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut'},], name: 'Profile', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style white noprint', id: 'NavFindAndSearch_button_Profile', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: false,},'InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=Profile]')[0].getMenu().hide(); }} }, {xtype: 'container', align: 'right', name: 'LoginOrSignUpContainer', layout: {type: 'hbox'}, scrollable: null, id: 'NavFindAndSearch_LoginOrSignUpContainer', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: false,},'!InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, items: [ {xtype: 'button', text: 'Log In', align: 'right', name: 'LoginForDualLogin', ui: 'white', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavFindAndSearch_button_LoginForDualLogin', listeners: {tap: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }} }, {xtype: 'label', html: 'or', align: 'right', name: 'Or', ui: 'body1-white', cls: 'hiddenxs hiddensm body1-white', id: 'NavFindAndSearch_Or' }, {xtype: 'button', text: 'Sign Up', align: 'right', name: 'SignUpForDualLogin', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavFindAndSearch_button_SignUpForDualLogin', listeners: {tap: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }} }] }, {xtype: 'button', accessibleText: 'Profile', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_1'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_1'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_1'},], name: 'ProfileIcon', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavFindAndSearch_button_ProfileIcon', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: true,},'InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=ProfileIcon]')[0].getMenu().hide(); }} }] }, {xtype: 'spacer', id: 'NavFindAndSearch_spacer_1', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }] }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'x-subheader-container', scrollable: null, id: 'NavFindAndSearch_container_1', items: [ {xtype: 'spacer', id: 'NavFindAndSearch_spacer_2', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn x-subheader-panel ', scrollable: null, id: 'NavFindAndSearch_container_2', items: [ {xtype: 'button', text: 'FP', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style x-button-provider-logo grey noprint', id: 'NavFindAndSearch_button_FP', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'vbox', pack: 'center', align: 'left'}, cls: 'im-provider-header-buttons', scrollable: null, id: 'NavFindAndSearch_container_3', items: [ {xtype: 'button', text: 'Foxhall Podiatry Associates, PC', name: 'SubheaderProviderName', ui: 'inline-dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style im-bold-button inline-dark-grey noprint', id: 'NavFindAndSearch_button_SubheaderProviderName', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'NavFindAndSearch_container_4', items: [ {xtype: 'container', html: '', hidden: true, cls: 'im-address-verification-icon', scrollable: null, id: 'NavFindAndSearch_container_5' }, {xtype: 'button', text: '3301 New Mexico Avenue, NW Suite 232, Washington, DC 20016', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style inline-grey noprint', id: 'NavFindAndSearch_button_3301NewMexicoAvenueNWSuite232W' }] }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, scrollable: null, id: 'NavFindAndSearch_container_6', items: [ {xtype: 'button', text: '(202) 966-4811', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style subheaderPhoneNumber inline-grey noprint', id: 'NavFindAndSearch_button_2029664811' }] }] }] }, {xtype: 'spacer', id: 'NavFindAndSearch_spacer_3', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }, { xtype: 'panel', dock: 'top', frame: false, scrollable: 'true', id: 'panel', items: [ {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'mainContent MainContentWithHeaerAndSubheader ', scrollable: null, id: 'container', items: [ {xtype: 'container', flex: 1, scrollable: null, id: 'container_1', items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, defaultSubmitButton: 'PayNow', name: 'formSearchPayment', itemId: 'formSearchPayment', cls: 'col-large-offSet-3 col-medium-offSet-3 col-small-offSet-1 smallTenColumn xsmallTwelveColumn mediumSixColumn largeSixColumn ', scrollable: null, id: 'formSearchPayment', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', hidden: true, cls: 'ErrorBox', id: 'ValidationSummary' }, {xtype: 'instamedHeading1', text: 'Make a Payment', id: 'formSearchPayment_instamedHeading1' }, {xtype: 'combobox', queryMode: 'local', triggerAction: 'all', typeAheadDelay: 300, itemId: 'Patient', displayField: 'description', store: Ext.create('Ext.data.ArrayStore',{ type: 'json', autoDestroy: false, storeId: 'PatientStore7', fields: [ { name: 'code', type: 'string' }, { name: 'description', type: 'string' } ], data: [['AB8FE4DC-3341-418D-AD03-A9A149595F4A', 'Add New'] ]}), valueField: 'code', forceSelection: true, picker: 'floated', clearable: true, editable: true, selectOnFocus: true, itemTpl: '{description}', displayTpl: '{description}', autoExpandOnFocus: true, validateOnBlank: false,listConfig: { id: 'formSearchPayment_Patient-boundlist', resizable: false }, fieldLabel: 'Patient Account', label: 'Patient Account', hidden: true, labelSeparator: ' ', placeholder: 'Select One', value: 'AB8FE4DC-3341-418D-AD03-A9A149595F4A', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient Account is required', autoComplete: 'off', name: 'Patient', margin: '', ariaRole: 'combobox', cls: 'x-trigger-field', id: 'formSearchPayment_Patient', listeners: {focus: function (cmp) { Ext.Function.defer(function (cmp) { if (!cmp.expanded & !cmp.readOnly && !cmp.isDisabled() && cmp.hasFocus) { cmp.onExpandTap(); } }, 250, this, [cmp]);},blur: function(cmp){if(cmp.validate){cmp.validate();}},select: function(cmp, newValue, oldValue, eOpts) {if (cmp.isRendered()) {myForm = InstaMed.findParentForm(cmp);PerformAction(myForm.getValues(),QuickPayOptimizedProviderLandingController.onPatientChange,cmp);}}} }, {xtype: 'container', name: 'PatientMatchFieldsContainer', scrollable: null, id: 'formSearchPayment_PatientMatchFieldsContainer', items: [ {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 200, maxLength: 200, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Email', label: 'Email', component: {"type":"email","pattern":null}, inputType: 'email', hidden: false, labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Email is required', autoComplete: 'on', name: 'EmailAddress', margin: '', id: 'formSearchPayment_EmailAddress', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 80, maxLength: 80, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Patient ID or Quick Pay Code', label: 'Patient ID or Quick Pay Code', hidden: false, labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient ID or Quick Pay Code is required', autoComplete: 'on', name: 'QuickPayComboID', margin: '', id: 'formSearchPayment_QuickPayComboID', listeners: {action: submitOnEnter,blur: function() { var listenerArgs = arguments; Ext.Array.each([function(cmp){if(cmp.validate){cmp.validate();}},function() { PerformAction({QuickPayCode:InstaMed.get('QuickPayComboID').getValue(),ProviderAlias:InstaMed.get('ProviderAlias').getValue()}, QuickPayOptimizedProviderLandingController.checkQuickPayCode,null); }], function(func) { func.apply(this, listenerArgs); }); },change: function(cmp){ var value = cmp.getValue(); var queryLength = [7,8,9]; if(queryLength.indexOf(value.length)!=-1){ PerformAction({QuickPayCode:InstaMed.get('QuickPayComboID').getValue(),ProviderAlias:InstaMed.get('ProviderAlias').getValue()}, QuickPayOptimizedProviderLandingController.checkQuickPayCode,this,null,null,true,null,null,true); } }} }, {xtype: 'textfield', maxLength: 80, maxLength: 80, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Medical Record #', label: 'Medical Record #', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Medical Record # is required', autoComplete: 'on', name: 'PatientMedicalRecordNumber', margin: '', id: 'formSearchPayment_PatientMedicalRecordNumber', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 80, maxLength: 80, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Guarantor ID', label: 'Guarantor ID', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Guarantor ID is required', autoComplete: 'on', name: 'GuarantorID', margin: '', id: 'formSearchPayment_GuarantorID', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 35, maxLength: 35, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Guarantor First Name', label: 'Guarantor First Name', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Guarantor First Name is required', autoComplete: 'on', name: 'GuarantorFirstName', margin: '', id: 'formSearchPayment_GuarantorFirstName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 60, maxLength: 60, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Guarantor Last Name', label: 'Guarantor Last Name', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Guarantor Last Name is required', autoComplete: 'on', name: 'GuarantorLastName', margin: '', id: 'formSearchPayment_GuarantorLastName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 35, maxLength: 35, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Patient First Name', label: 'Patient First Name', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient First Name is required', autoComplete: 'on', name: 'PatientFirstName', margin: '', id: 'formSearchPayment_PatientFirstName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 60, maxLength: 60, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Patient Last Name', label: 'Patient Last Name', hidden: false, labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient Last Name is required', autoComplete: 'on', name: 'PatientLastName', margin: '', id: 'formSearchPayment_PatientLastName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 25, maxLength: 25, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Patient Middle Name', label: 'Patient Middle Name', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient Middle Name is required', autoComplete: 'on', name: 'PatientMiddleName', margin: '', id: 'formSearchPayment_PatientMiddleName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'datepickerfield', picker: { cancelButton: false, toolbar : { items : [ { text : 'Clear', align : 'left', handler : function(btn) { var picker = btn.up('datepicker'); picker.fireEvent('change', picker, null); picker.setValue(picker.config.value); picker.hide(); } } ] } , value: new Date(), yearFrom: 1900, yearTo: 2028 }, floatedPicker: { xtype: 'datepanel', minDate: new Date('1/1/1900 12:00:00 AM'), maxDate: new Date('12/31/2028 12:00:00 AM'), yearPicker: { start: 1900, end: 2028, } }, minDate: new Date('1/1/1900 12:00:00 AM'), maxDate: new Date('12/31/2028 12:00:00 AM'), submitFormat: 'm/d/Y', showToday: true, badFormatMessage: 'Patient Birth Date format is MM/DD/YYYY', validateOnBlank: false, fieldLabel: 'Patient Birth Date', label: 'Patient Birth Date', hidden: true, labelSeparator: ' ', placeholder: 'MM/DD/YYYY', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient Birth Date is required', autoComplete: 'on', name: 'PatientBirthDate', margin: '', id: 'formSearchPayment_PatientBirthDate', listeners: {blur: function() { var listenerArgs = arguments; Ext.Array.each([function(cmp){ var value = cmp.getValue(); if(value & typeof value == 'string') { value = new Date(value); } cmp.setValue(value); if(InstaMed.isResponsive){ cmp.setInputValue(value); } },function(cmp){if(cmp.validate){cmp.validate();}}], function(func) { func.apply(this, listenerArgs); }); }} }, {xtype: 'textfield', maxLength: 14, maxLength: 14, enforceMaxLength: true, minLength: 10, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Patient Phone #', label: 'Patient Phone #', component: {"type":"tel","pattern":null}, inputType: 'tel', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient Phone # is required', autoComplete: 'on', name: 'PatientPhoneNumber', margin: '', id: 'formSearchPayment_PatientPhoneNumber', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}},change: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null & s != '') { s = s.replace(/[-,()\s]/g,'');var newValue='(';newValue+=s.substring(0,3);if(s.length>3){newValue+=') ';}newValue+=s.substring(3,6);if(s.length>6){newValue+='-';}newValue+=s.substring(6,10); if(isNaN(parseInt(newValue.substring(1,3)))){ newValue = ''; } field.setValue(newValue); if(InstaMed.isResponsive){ field.setInputValue(newValue); } } }} }, {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 10, maxLength: 10, enforceMaxLength: true, minLength: 3, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Patient Zip', label: 'Patient Zip', hidden: false, labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient Zip is required', autoComplete: 'on', name: 'PatientZip', margin: '', id: 'formSearchPayment_PatientZip', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}},change: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null & s != '') { s = s.replace(/[^0-9]/g,'');if(s.length>5){s = [s.slice(0,5),'-',s.slice(5,9)].join('');}field.setValue(s); if(InstaMed.isResponsive){ field.setInputValue(s); } } }} }, {xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Statement Number', label: 'Statement Number', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Statement Number is required', autoComplete: 'off', name: 'StatementNumber', margin: '', id: 'formSearchPayment_StatementNumber', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'datepickerfield', picker: { cancelButton: false, toolbar : { items : [ { text : 'Clear', align : 'left', handler : function(btn) { var picker = btn.up('datepicker'); picker.fireEvent('change', picker, null); picker.setValue(picker.config.value); picker.hide(); } } ] } , value: new Date(), yearFrom: 1900, yearTo: 2028 }, floatedPicker: { xtype: 'datepanel', minDate: new Date('1/1/1900 12:00:00 AM'), maxDate: new Date('12/31/2028 12:00:00 AM'), yearPicker: { start: 1900, end: 2028, } }, minDate: new Date('1/1/1900 12:00:00 AM'), maxDate: new Date('12/31/2028 12:00:00 AM'), submitFormat: 'm/d/Y', showToday: true, badFormatMessage: 'Statement Date format is MM/DD/YYYY', validateOnBlank: false, fieldLabel: 'Statement Date', label: 'Statement Date', hidden: true, labelSeparator: ' ', placeholder: 'MM/DD/YYYY', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Statement Date is required', autoComplete: 'off', name: 'StatementDate', margin: '', id: 'formSearchPayment_StatementDate', listeners: {blur: function() { var listenerArgs = arguments; Ext.Array.each([function(cmp){ var value = cmp.getValue(); if(value & typeof value == 'string') { value = new Date(value); } cmp.setValue(value); if(InstaMed.isResponsive){ cmp.setInputValue(value); } },function(cmp){if(cmp.validate){cmp.validate();}}], function(func) { func.apply(this, listenerArgs); }); }} }, {xtype: 'amountfield', regex: /^[\$]?\d{1,3}(\,?\d{3,3})*(\.(\d|\d\d))?$/i, regexText: 'Please enter a valid dollar amount.', maxLength: 12, maxLength: 12, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, maskRe: /[\$\d\.\,]/i, fieldLabel: 'Amount Due', label: 'Amount Due', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Amount Due is required', autoComplete: 'off', name: 'AmountDue', margin: '', id: 'formSearchPayment_AmountDue', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Client ID', label: 'Client ID', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Client ID is required', autoComplete: 'on', name: 'ClientID', margin: '', id: 'formSearchPayment_ClientID', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 500, maxLength: 500, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Provider ID', label: 'Provider ID', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Provider ID is required', autoComplete: 'on', name: 'ProviderID', margin: '', id: 'formSearchPayment_ProviderID', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 500, maxLength: 500, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Provider Name', label: 'Provider Name', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Provider Name is required', autoComplete: 'off', name: 'ProviderName', margin: '', id: 'formSearchPayment_ProviderName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 50, maxLength: 50, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Provider Street 1', label: 'Provider Street 1', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Provider Street 1 is required', autoComplete: 'off', name: 'ProviderStreet1', margin: '', id: 'formSearchPayment_ProviderStreet1', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 50, maxLength: 50, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Provider Street 2', label: 'Provider Street 2', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Provider Street 2 is required', autoComplete: 'off', name: 'ProviderStreet2', margin: '', id: 'formSearchPayment_ProviderStreet2', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 30, maxLength: 30, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Provider City', label: 'Provider City', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Provider City is required', autoComplete: 'off', name: 'ProviderCity', margin: '', id: 'formSearchPayment_ProviderCity', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'combobox', queryMode: 'local', triggerAction: 'all', typeAheadDelay: 300, itemId: 'ProviderState', displayField: 'description', store: 'ApplicationStateComboboxStore', valueField: 'code', forceSelection: true, picker: 'floated', clearable: true, editable: true, selectOnFocus: true, multiSelect: false, itemTpl: '{[Ext.util.Format.htmlEncode(values.description)]}', displayTpl: '{description}', autoExpandOnFocus: true, validateOnBlank: false,listConfig: { id: 'formSearchPayment_ProviderState-boundlist', resizable: false, getInnerTpl: function() { return '{[Ext.util.Format.htmlEncode(values.description)]}'; } }, fieldLabel: 'Provider State', label: 'Provider State', hidden: true, labelSeparator: ' ', placeholder: 'Select One', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, allowAutoFill: true, requiredMessage: 'Provider State is required', autoComplete: 'off', name: 'ProviderState', margin: '', ariaRole: 'combobox', cls: 'x-trigger-field', id: 'formSearchPayment_ProviderState', listeners: {focus: function (cmp) { Ext.Function.defer(function (cmp) { if (!cmp.expanded & !cmp.readOnly && !cmp.isDisabled() && cmp.hasFocus) { cmp.onExpandTap(); } }, 250, this, [cmp]);},blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 10, maxLength: 10, enforceMaxLength: true, minLength: 3, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Provider Zip', label: 'Provider Zip', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Provider Zip is required', autoComplete: 'off', name: 'ProviderZip', margin: '', id: 'formSearchPayment_ProviderZip', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}},change: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null & s != '') { s = s.replace(/[^0-9]/g,'');if(s.length>5){s = [s.slice(0,5),'-',s.slice(5,9)].join('');}field.setValue(s); if(InstaMed.isResponsive){ field.setInputValue(s); } } }} }, {xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Dynamic Field 1', label: 'Dynamic Field 1', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Dynamic Field 1 is required', autoComplete: 'off', name: 'DynamicField1', margin: '', id: 'formSearchPayment_DynamicField1', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Dynamic Field 2', label: 'Dynamic Field 2', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Dynamic Field 2 is required', autoComplete: 'off', name: 'DynamicField2', margin: '', id: 'formSearchPayment_DynamicField2', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 100, maxLength: 100, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Dynamic Field 3', label: 'Dynamic Field 3', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Dynamic Field 3 is required', autoComplete: 'off', name: 'DynamicField3', margin: '', id: 'formSearchPayment_DynamicField3', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', maxLength: 80, maxLength: 80, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Dynamic Field 4', label: 'Dynamic Field 4', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Dynamic Field 4 is required', autoComplete: 'off', name: 'DynamicField4', margin: '', id: 'formSearchPayment_DynamicField4', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'ProviderAlias', label: 'ProviderAlias', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'ProviderAlias is required', autoComplete: 'on', name: 'ProviderAlias', margin: '', id: 'formSearchPayment_ProviderAlias', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }] }, {xtype: 'hiddenfield', fieldLabel: 'QuickPayFlowFromPaymentPage', label: 'QuickPayFlowFromPaymentPage', labelSeparator: ' ', value: true, required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'QuickPayFlowFromPaymentPage is required', autoComplete: 'on', name: 'QuickPayFlowFromPaymentPage', margin: '', id: 'formSearchPayment_QuickPayFlowFromPaymentPage', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', margin: '16 0 16 0', scrollable: null, id: 'formSearchPayment_container', items: [ {xtype: 'button', text: 'Pay Now', name: 'PayNow', ui: 'wide', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-action wide noprint', id: 'formSearchPayment_button_PayNow', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),QuickPayOptimizedProviderLandingController.payNow,cmp,undefined,undefined,undefined,undefined,undefined); }} }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, cls: 'buttonContainer', scrollable: null, id: 'formSearchPayment_container_1', items: [ {xtype: 'spacer', id: 'formSearchPayment_spacer' }, {xtype: 'button', text: 'Next', ui: 'action', margin: '', ariaRole: 'button', cls: 'action noprint', id: 'formSearchPayment_button_Next', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),QuickPayOptimizedProviderLandingController.payNow,cmp,undefined,undefined,undefined,undefined,undefined); }} }] }, {xtype: 'container', html: 'Don\'t have the information above? Pay Here', cls: 'donthaveinformation', scrollable: null, id: 'formSearchPayment_container_2' }] }] }] }] }, {xtype: 'spacer', flex: 1, id: 'spacer' }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, cls: 'x-panel-footer im-powered-by', scrollable: null, id: 'container_2', items: [ {xtype: 'spacer', id: 'spacer_1' }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn ', scrollable: null, id: 'NavFindAndSearch_container_7', items: [ {xtype: 'image', name: 'poweredbylogo', cls: 'hidden hiddenxs hiddensm', id: 'NavFindAndSearch_poweredbylogo' }, {xtype: 'container', cls: 'copyrightContainer hiddenxs hiddensm', scrollable: null, id: 'NavFindAndSearch_container_8', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavFindAndSearch_spacer_4' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavFindAndSearch_button_copyrightFooter' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavFindAndSearch_spacer_5' }] }, {xtype: 'spacer', cls: 'hiddenxs hiddensm', id: 'NavFindAndSearch_spacer_6' }, {xtype: 'container', cls: 'linkButtonContainer hiddenxs hiddensm', scrollable: null, id: 'NavFindAndSearch_container_9', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_Security', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_Privacy', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_Terms', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_Help', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }, {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenxs hiddensm', id: 'menuitem_en'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenxs hiddensm', id: 'menuitem_es'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenxs hiddensm', id: 'menuitem_fr'},], name: 'ForeignLanguages', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_ForeignLanguages' }] }, {xtype: 'container', cls: 'hiddenmd hiddenlg', scrollable: null, id: 'NavFindAndSearch_container_10', items: [ {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavFindAndSearch_container_11', items: [ {xtype: 'spacer', id: 'NavFindAndSearch_spacer_7' }, {xtype: 'image', name: 'poweredbylogo', cls: 'hidden', id: 'NavFindAndSearch_poweredbylogo_1' }, {xtype: 'spacer', id: 'NavFindAndSearch_spacer_8' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavFindAndSearch_container_12', items: [ {xtype: 'spacer', id: 'NavFindAndSearch_spacer_9' }, {xtype: 'container', cls: 'copyrightContainer', scrollable: null, id: 'NavFindAndSearch_container_13', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavFindAndSearch_spacer_10' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavFindAndSearch_button_copyrightFooter_1' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavFindAndSearch_spacer_11' }] }, {xtype: 'spacer', id: 'NavFindAndSearch_spacer_12' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavFindAndSearch_container_14', items: [ {xtype: 'spacer', id: 'NavFindAndSearch_spacer_13' }, {xtype: 'container', cls: 'linkButtonContainer ', scrollable: null, id: 'NavFindAndSearch_container_15', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_Security_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_Privacy_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_Terms_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_Help_1', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }] }, {xtype: 'spacer', id: 'NavFindAndSearch_spacer_14' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavFindAndSearch_container_16', items: [ {xtype: 'spacer', id: 'NavFindAndSearch_spacer_15' }, {xtype: 'container', scrollable: null, id: 'NavFindAndSearch_container_17', items: [ {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenmd hiddenlg', id: 'menuitem_en_1'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenmd hiddenlg', id: 'menuitem_es_1'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenmd hiddenlg', id: 'menuitem_fr_1'},], name: 'ForeignLanguages', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavFindAndSearch_button_ForeignLanguages_1' }] }, {xtype: 'spacer', id: 'NavFindAndSearch_spacer_16' }] }] }] }, {xtype: 'spacer', id: 'spacer_2' }] }] }, {xtype: 'container', name: 'NavQuickPayPatientEntry', layout: {type: 'vbox', pack: 'start'}, showBackButton: true, showMenuButton: false, scrollable: 'true', id: 'NavQuickPayPatientEntry', items: [ {xtype: 'container', docked: 'top', scrollable: null, id: 'NavQuickPayPatientEntry_container', items: [ {xtype: 'instamedNavigationBar', name: 'headerBar', layout: {type: 'hbox'}, hidden: false, cls: 'im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavQuickPayPatientEntry_headerBar', items: [ {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'titlebar', title: '<a href=\\"../../Form/PaymentPortal/Start\\"> <img width=\\"101\\" height=\\"32\\" src=\\"../../Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry\\">', maxWidth: 1272, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavQuickPayPatientEntry_titlebar', plugins: 'responsive', responsiveConfig: {'width >= 1272':{title :'',},'width < 1272':{title : ' ',},}, items: [ {xtype: 'button', accessibleText: 'Back', iconCls: 'x-ma ma-arrow-back', align: 'left', name: 'TitleBarNavigationViewBack', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-icon-link-style white hiddenlg noprint', id: 'NavQuickPayPatientEntry_TitleBarNavigationViewBack', plugins: 'responsive', responsiveConfig: {'width > 1272':{iconCls :'',},'width <= 1272':{iconCls : 'x-ma ma-arrow-back',},}, listeners: {tap: function() { PerformAction({}, QuickPayPatientEntryController.navigateBack,null); }} }, {xtype: 'image', width: 127, height: 40, src: 'https://instamedprd.cachefly.net/V_2022_August/Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry', align: 'left', cls: 'x-clickable x-image-size-contain', id: 'NavQuickPayPatientEntry_image', plugins: 'responsive', responsiveConfig: {'width >= 1272':{hidden : false,},'width < 1272':{hidden :true,},}, listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Start'; }} }, {xtype: 'button', name: 'HeaderTitlebarButton', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style im-center-header-button white noprint', id: 'NavQuickPayPatientEntry_HeaderTitlebarButton' }, {xtype: 'button', text: 'Pay Any Healthcare Bill', align: 'right', name: 'PayAnyHealthcareBillButton', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style x-border hiddenxs hiddensm white noprint', id: 'NavQuickPayPatientEntry_button_PayAnyHealthcareBill', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?id=foxhallpodiatry&pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', text: 'Pay Bills', iconCls: 'x-ma ma-search', iconAlign: 'top', align: 'right', name: 'PayAnyHealthcareBillIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-ontop-link-style white hiddenmd hiddenlg noprint', id: 'NavQuickPayPatientEntry_button_PayBills', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', accessibleText: 'Log In or Sign Up', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Log In', handler: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }, id: 'menuitem_LogIn_1'},{xtype: 'menuitem', text: 'Sign Up', handler: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }, id: 'menuitem_SignUp_1'},], name: 'LoginOrSignUpProfileIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavQuickPayPatientEntry_button_LoginOrSignUpProfileIcon', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: true,},'!InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=LoginOrSignUpProfileIcon]')[0].getMenu().hide(); }} }, {xtype: 'button', text: '', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_2'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_2'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_2'},], name: 'Profile', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style white noprint', id: 'NavQuickPayPatientEntry_button_Profile', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: false,},'InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=Profile]')[0].getMenu().hide(); }} }, {xtype: 'container', align: 'right', name: 'LoginOrSignUpContainer', layout: {type: 'hbox'}, scrollable: null, id: 'NavQuickPayPatientEntry_LoginOrSignUpContainer', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: false,},'!InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, items: [ {xtype: 'button', text: 'Log In', align: 'right', name: 'LoginForDualLogin', ui: 'white', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavQuickPayPatientEntry_button_LoginForDualLogin', listeners: {tap: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }} }, {xtype: 'label', html: 'or', align: 'right', name: 'Or', ui: 'body1-white', cls: 'hiddenxs hiddensm body1-white', id: 'NavQuickPayPatientEntry_Or' }, {xtype: 'button', text: 'Sign Up', align: 'right', name: 'SignUpForDualLogin', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavQuickPayPatientEntry_button_SignUpForDualLogin', listeners: {tap: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }} }] }, {xtype: 'button', accessibleText: 'Profile', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_3'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_3'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_3'},], name: 'ProfileIcon', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavQuickPayPatientEntry_button_ProfileIcon', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: true,},'InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=ProfileIcon]')[0].getMenu().hide(); }} }] }, {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_1', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }] }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'x-subheader-container', scrollable: null, id: 'NavQuickPayPatientEntry_container_1', items: [ {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_2', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn x-subheader-panel ', scrollable: null, id: 'NavQuickPayPatientEntry_container_2', items: [ {xtype: 'button', text: 'FP', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style x-button-provider-logo grey noprint', id: 'NavQuickPayPatientEntry_button_FP', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'vbox', pack: 'center', align: 'left'}, cls: 'im-provider-header-buttons', scrollable: null, id: 'NavQuickPayPatientEntry_container_3', items: [ {xtype: 'button', text: 'Foxhall Podiatry Associates, PC', name: 'SubheaderProviderName', ui: 'inline-dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style im-bold-button inline-dark-grey noprint', id: 'NavQuickPayPatientEntry_button_SubheaderProviderName', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'NavQuickPayPatientEntry_container_4', items: [ {xtype: 'container', html: '', hidden: true, cls: 'im-address-verification-icon', scrollable: null, id: 'NavQuickPayPatientEntry_container_5' }, {xtype: 'button', text: '3301 New Mexico Avenue, NW Suite 232, Washington, DC 20016', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style inline-grey noprint', id: 'NavQuickPayPatientEntry_button_3301NewMexicoAvenueNWSuit' }] }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, scrollable: null, id: 'NavQuickPayPatientEntry_container_6', items: [ {xtype: 'button', text: '(202) 966-4811', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style subheaderPhoneNumber inline-grey noprint', id: 'NavQuickPayPatientEntry_button_2029664811' }] }] }] }, {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_3', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }, { xtype: 'panel', dock: 'top', frame: false, scrollable: 'true', id: 'panel_1', items: [ {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'mainContent MainContentWithHeaerAndSubheader ', scrollable: null, id: 'container_3', items: [ {xtype: 'container', flex: 1, scrollable: null, id: 'container_4', items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, name: 'FormPatientPayment', itemId: 'FormPatientPayment', cls: 'col-large-offSet-3 col-medium-offSet-3 col-small-offSet-1 smallTenColumn xsmallTwelveColumn mediumSixColumn largeSixColumn ', scrollable: null, id: 'FormPatientPayment', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_1' }, {xtype: 'instamedHeading1', text: 'Patient Information', id: 'FormPatientPayment_instamedHeading1' }, {xtype: 'dataviewlite', tpl: [' {PatientFirstName:htmlEncode} {PatientLastName:htmlEncode} ({PatientID:htmlEncode}) {PatientFirstName:htmlEncode} {PatientLastName:htmlEncode} ${Amount:htmlEncode} Edit Remove '], itemSelector: '.patientItem', emptyText: '', deferInitialRefresh: false,store: Ext.data.StoreManager.lookup('PatientPaymentPatientInfoMultiARDataViewstore'), name: 'PatientPaymentPatientInfoMultiARDataView', id: 'FormPatientPayment_PatientPaymentPatientInfoMultiARDataView' }, {xtype: 'instameddisplayfield', fieldLabel: 'Patient Balance', label: 'Patient Balance', readOnly: true, hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'top', errorTarget: 'under', clearable: false, requiredMessage: 'Patient Balance is required', autoComplete: 'on', name: 'PatientBalance', ui: 'payment-flow', margin: '', ariaRole: '', cls: 'im-display-field payment-flow', id: 'FormPatientPayment_PatientBalance', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'amountfield', regex: /^[\$]?\d{1,3}(\,?\d{3,3})*(\.(\d|\d\d))?$/i, regexText: 'Please enter a valid dollar amount.', allowBlank: false, allowOnlyWhitespace: false, maxLength: 12, maxLength: 12, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, maskRe: /[\$\d\.\,]/i, fieldLabel: 'Amount', label: 'Amount', hidden: true, labelSeparator: ' ', resetValue: '', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Amount is required', autoComplete: 'off', name: 'Amount', margin: '', id: 'FormPatientPayment_Amount', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'Payment Account', label: 'Payment Account', readOnly: false, labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'Payment Account is required', autoComplete: 'on', name: 'PaymentPlanEntityID', margin: '', id: 'FormPatientPayment_PaymentPlanEntityID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 50, maxLength: 50, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Patient ID', label: 'Patient ID', readOnly: false, hidden: false, labelSeparator: ' ', resetValue: '', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Patient ID is required', autoComplete: 'on', name: 'PatientID', margin: '', id: 'FormPatientPayment_PatientID', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'MultipleFieldsContainer', scrollable: null, id: 'FormPatientPayment_container', plugins: 'responsive', responsiveConfig: {'width > 600':{layout : { type : 'hbox'},},'width <= 600':{layout : { type : 'vbox'},},}, items: [ {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 35, maxLength: 35, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'First Name', label: 'First Name', readOnly: false, disabled: false, hidden: false, labelSeparator: ' ', resetValue: '', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'First Name is required', autoComplete: 'on', name: 'PatientFirstName', flex: 1, margin: '', id: 'FormPatientPayment_PatientFirstName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', width: 24, name: 'PatientFirstNamePatientLastNameSpacer', hidden: false, cls: 'x-spacer', id: 'FormPatientPayment_PatientFirstNamePatientLastNameSpacer' }, {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 60, maxLength: 60, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Last Name', label: 'Last Name', readOnly: false, disabled: false, hidden: false, labelSeparator: ' ', resetValue: '', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Last Name is required', autoComplete: 'on', name: 'PatientLastName', flex: 1, margin: '', id: 'FormPatientPayment_PatientLastName', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }] }, {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 200, maxLength: 200, enforceMaxLength: true, minLength: 1, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Email Address', label: 'Email Address', component: {"type":"email","pattern":null}, inputType: 'email', readOnly: false, hidden: false, labelSeparator: ' ', resetValue: '', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Email Address is required', autoComplete: 'on', name: 'AccountHolderEmail', margin: '', id: 'FormPatientPayment_AccountHolderEmail', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'WalletPatientEntityID', label: 'WalletPatientEntityID', readOnly: false, labelSeparator: ' ', resetValue: '', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'WalletPatientEntityID is required', autoComplete: 'on', name: 'WalletPatientEntityID', margin: '', id: 'FormPatientPayment_WalletPatientEntityID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'PatientEntityID', label: 'PatientEntityID', readOnly: false, labelSeparator: ' ', resetValue: '', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'PatientEntityID is required', autoComplete: 'on', name: 'PatientEntityID', margin: '', id: 'FormPatientPayment_PatientEntityID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'MultipleFieldsContainer', scrollable: null, id: 'FormPatientPayment_container_1', plugins: 'responsive', responsiveConfig: {'width > 600':{layout : { type : 'hbox'},},'width <= 600':{layout : { type : 'vbox'},},}, items: [ {xtype: 'container', width: 24, name: 'PatientServiceBeginDatePatientServiceEndDateSpacer', cls: 'x-spacer', id: 'FormPatientPayment_PatientServiceBeginDatePatientServiceEndDat' }] }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'MultipleFieldsContainer', scrollable: null, id: 'FormPatientPayment_container_2', plugins: 'responsive', responsiveConfig: {'width > 600':{layout : { type : 'hbox'},},'width <= 600':{layout : { type : 'vbox'},},}, items: [ {xtype: 'container', width: 24, name: 'PatientAddress1PatientAddress2Spacer', cls: 'x-spacer', id: 'FormPatientPayment_PatientAddress1PatientAddress2Spacer' }] }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'MultipleFieldsContainer', scrollable: null, id: 'FormPatientPayment_container_3', plugins: 'responsive', responsiveConfig: {'width > 600':{layout : { type : 'hbox'},},'width <= 600':{layout : { type : 'vbox'},},}, items: [] }, {xtype: 'hiddenfield', fieldLabel: 'LineItemKey', label: 'LineItemKey', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'LineItemKey is required', autoComplete: 'on', name: 'LineItemKey', margin: '', id: 'FormPatientPayment_LineItemKey', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'Guarantor Name', label: 'Guarantor Name', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'Guarantor Name is required', autoComplete: 'on', name: 'GuarantorName', margin: '', id: 'FormPatientPayment_GuarantorName', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, cls: 'buttonContainer', scrollable: null, id: 'FormPatientPayment_container_4', items: [ {xtype: 'button', text: 'Cancel Edit', name: 'btnCancelEditPatient', margin: '', hidden: true, ariaRole: 'button', cls: 'noprint', id: 'FormPatientPayment_button_CancelEdit', listeners: {tap: cancelEditLineItem} }, {xtype: 'spacer', id: 'FormPatientPayment_spacer' }, {xtype: 'button', text: 'Back', name: 'btnBack', ui: 'secondary', margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'FormPatientPayment_button_Back', listeners: {tap: function() { PerformAction({}, QuickPayPatientEntryController.navigateBack,null); }} }, {xtype: 'button', text: 'Next', name: 'btnNext', ui: 'action', margin: '', ariaRole: 'button', cls: 'action noprint', id: 'FormPatientPayment_button_Next', listeners: {tap: function(cmp, e, options) { var cmpForm = InstaMed.findParentForm(cmp); var myForm = cmpForm.getForm(); var data = myForm.getValues(); var records = InstaMed.get('PatientPaymentPatientInfoMultiARDataView').getStore().getRange(); data = myForm.getValues(); data['LineItems'] = []; data['UIAction'] = 'Default'; Ext.each(records, function(rec) { var lineItem = rec.data; lineItem.requestKey = Ext.app.REMOTING_API.requestKey; lineItem.singleSignOnToken = Ext.app.REMOTING_API.token; data['LineItems'].push(lineItem); }); var blockAction = !false; if(blockAction){PerformAction(data, QuickPayPatientEntryController.submitPatient);} }} }, {xtype: 'button', text: 'Update Patient', name: 'btnUpdatePatient', ui: 'action', margin: '', hidden: true, ariaRole: 'button', cls: 'action noprint', id: 'FormPatientPayment_button_UpdatePatient', listeners: {tap: function(cmp, e, options) { var cmpForm = InstaMed.findParentForm(cmp); var myForm = cmpForm.getForm(); var data = myForm.getValues(); var records = InstaMed.get('PatientPaymentPatientInfoMultiARDataView').getStore().getRange(); data = myForm.getValues(); data['LineItems'] = []; data['UIAction'] = 'Default'; Ext.each(records, function(rec) { var lineItem = rec.data; lineItem.requestKey = Ext.app.REMOTING_API.requestKey; lineItem.singleSignOnToken = Ext.app.REMOTING_API.token; data['LineItems'].push(lineItem); }); var blockAction = !false; if(blockAction){PerformAction(data, QuickPayPatientEntryController.updatePatient, null, cancelEditLineItem);} }} }] }] }] }] }] }, {xtype: 'spacer', flex: 1, id: 'spacer_3' }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, cls: 'x-panel-footer im-powered-by', scrollable: null, id: 'container_5', items: [ {xtype: 'spacer', id: 'spacer_4' }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn ', scrollable: null, id: 'NavQuickPayPatientEntry_container_7', items: [ {xtype: 'image', name: 'poweredbylogo', cls: 'hidden hiddenxs hiddensm', id: 'NavQuickPayPatientEntry_poweredbylogo' }, {xtype: 'container', cls: 'copyrightContainer hiddenxs hiddensm', scrollable: null, id: 'NavQuickPayPatientEntry_container_8', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavQuickPayPatientEntry_spacer_4' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavQuickPayPatientEntry_button_copyrightFooter' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavQuickPayPatientEntry_spacer_5' }] }, {xtype: 'spacer', cls: 'hiddenxs hiddensm', id: 'NavQuickPayPatientEntry_spacer_6' }, {xtype: 'container', cls: 'linkButtonContainer hiddenxs hiddensm', scrollable: null, id: 'NavQuickPayPatientEntry_container_9', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_Security', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_Privacy', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_Terms', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_Help', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }, {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenxs hiddensm', id: 'menuitem_en_2'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenxs hiddensm', id: 'menuitem_es_2'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenxs hiddensm', id: 'menuitem_fr_2'},], name: 'ForeignLanguages', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_ForeignLanguages' }] }, {xtype: 'container', cls: 'hiddenmd hiddenlg', scrollable: null, id: 'NavQuickPayPatientEntry_container_10', items: [ {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavQuickPayPatientEntry_container_11', items: [ {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_7' }, {xtype: 'image', name: 'poweredbylogo', cls: 'hidden', id: 'NavQuickPayPatientEntry_poweredbylogo_1' }, {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_8' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavQuickPayPatientEntry_container_12', items: [ {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_9' }, {xtype: 'container', cls: 'copyrightContainer', scrollable: null, id: 'NavQuickPayPatientEntry_container_13', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavQuickPayPatientEntry_spacer_10' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavQuickPayPatientEntry_button_copyrightFooter_1' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavQuickPayPatientEntry_spacer_11' }] }, {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_12' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavQuickPayPatientEntry_container_14', items: [ {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_13' }, {xtype: 'container', cls: 'linkButtonContainer ', scrollable: null, id: 'NavQuickPayPatientEntry_container_15', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_Security_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_Privacy_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_Terms_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_Help_1', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }] }, {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_14' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavQuickPayPatientEntry_container_16', items: [ {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_15' }, {xtype: 'container', scrollable: null, id: 'NavQuickPayPatientEntry_container_17', items: [ {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenmd hiddenlg', id: 'menuitem_en_3'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenmd hiddenlg', id: 'menuitem_es_3'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenmd hiddenlg', id: 'menuitem_fr_3'},], name: 'ForeignLanguages', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayPatientEntry_button_ForeignLanguages_1' }] }, {xtype: 'spacer', id: 'NavQuickPayPatientEntry_spacer_16' }] }] }] }, {xtype: 'spacer', id: 'spacer_5' }] }] }, {xtype: 'container', name: 'NavQuickPayAccountSummary', layout: {type: 'vbox', pack: 'start'}, showBackButton: true, showMenuButton: false, scrollable: 'true', id: 'NavQuickPayAccountSummary', items: [ {xtype: 'container', docked: 'top', scrollable: null, id: 'NavQuickPayAccountSummary_container', items: [ {xtype: 'instamedNavigationBar', name: 'headerBar', layout: {type: 'hbox'}, hidden: false, cls: 'im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavQuickPayAccountSummary_headerBar', items: [ {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'titlebar', title: '<a href=\\"../../Form/PaymentPortal/Start\\"> <img width=\\"101\\" height=\\"32\\" src=\\"../../Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry\\">', maxWidth: 1272, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavQuickPayAccountSummary_titlebar', plugins: 'responsive', responsiveConfig: {'width >= 1272':{title :'',},'width < 1272':{title : ' ',},}, items: [ {xtype: 'button', accessibleText: 'Back', iconCls: 'x-ma ma-arrow-back', align: 'left', name: 'TitleBarNavigationViewBack', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-icon-link-style white hiddenlg noprint', id: 'NavQuickPayAccountSummary_TitleBarNavigationViewBack', plugins: 'responsive', responsiveConfig: {'width > 1272':{iconCls :'',},'width <= 1272':{iconCls : 'x-ma ma-arrow-back',},}, listeners: {tap: function() { PerformAction({}, QuickPayPatientEntryController.navigateBack,null); }} }, {xtype: 'image', width: 127, height: 40, src: 'https://instamedprd.cachefly.net/V_2022_August/Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry', align: 'left', cls: 'x-clickable x-image-size-contain', id: 'NavQuickPayAccountSummary_image', plugins: 'responsive', responsiveConfig: {'width >= 1272':{hidden : false,},'width < 1272':{hidden :true,},}, listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Start'; }} }, {xtype: 'button', name: 'HeaderTitlebarButton', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style im-center-header-button white noprint', id: 'NavQuickPayAccountSummary_HeaderTitlebarButton' }, {xtype: 'button', text: 'Pay Any Healthcare Bill', align: 'right', name: 'PayAnyHealthcareBillButton', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style x-border hiddenxs hiddensm white noprint', id: 'NavQuickPayAccountSummary_button_PayAnyHealthcareBill', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?id=foxhallpodiatry&pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', text: 'Pay Bills', iconCls: 'x-ma ma-search', iconAlign: 'top', align: 'right', name: 'PayAnyHealthcareBillIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-ontop-link-style white hiddenmd hiddenlg noprint', id: 'NavQuickPayAccountSummary_button_PayBills', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', accessibleText: 'Log In or Sign Up', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Log In', handler: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }, id: 'menuitem_LogIn_2'},{xtype: 'menuitem', text: 'Sign Up', handler: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }, id: 'menuitem_SignUp_2'},], name: 'LoginOrSignUpProfileIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavQuickPayAccountSummary_button_LoginOrSignUpProfileIcon', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: true,},'!InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=LoginOrSignUpProfileIcon]')[0].getMenu().hide(); }} }, {xtype: 'button', text: '', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_4'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_4'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_4'},], name: 'Profile', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style white noprint', id: 'NavQuickPayAccountSummary_button_Profile', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: false,},'InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=Profile]')[0].getMenu().hide(); }} }, {xtype: 'container', align: 'right', name: 'LoginOrSignUpContainer', layout: {type: 'hbox'}, scrollable: null, id: 'NavQuickPayAccountSummary_LoginOrSignUpContainer', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: false,},'!InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, items: [ {xtype: 'button', text: 'Log In', align: 'right', name: 'LoginForDualLogin', ui: 'white', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavQuickPayAccountSummary_button_LoginForDualLogin', listeners: {tap: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }} }, {xtype: 'label', html: 'or', align: 'right', name: 'Or', ui: 'body1-white', cls: 'hiddenxs hiddensm body1-white', id: 'NavQuickPayAccountSummary_Or' }, {xtype: 'button', text: 'Sign Up', align: 'right', name: 'SignUpForDualLogin', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavQuickPayAccountSummary_button_SignUpForDualLogin', listeners: {tap: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }} }] }, {xtype: 'button', accessibleText: 'Profile', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_5'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_5'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_5'},], name: 'ProfileIcon', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavQuickPayAccountSummary_button_ProfileIcon', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: true,},'InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=ProfileIcon]')[0].getMenu().hide(); }} }] }, {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_1', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }] }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'x-subheader-container', scrollable: null, id: 'NavQuickPayAccountSummary_container_1', items: [ {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_2', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn x-subheader-panel ', scrollable: null, id: 'NavQuickPayAccountSummary_container_2', items: [ {xtype: 'button', text: 'FP', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style x-button-provider-logo grey noprint', id: 'NavQuickPayAccountSummary_button_FP', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'vbox', pack: 'center', align: 'left'}, cls: 'im-provider-header-buttons', scrollable: null, id: 'NavQuickPayAccountSummary_container_3', items: [ {xtype: 'button', text: 'Foxhall Podiatry Associates, PC', name: 'SubheaderProviderName', ui: 'inline-dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style im-bold-button inline-dark-grey noprint', id: 'NavQuickPayAccountSummary_button_SubheaderProviderName', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'NavQuickPayAccountSummary_container_4', items: [ {xtype: 'container', html: '', hidden: true, cls: 'im-address-verification-icon', scrollable: null, id: 'NavQuickPayAccountSummary_container_5' }, {xtype: 'button', text: '3301 New Mexico Avenue, NW Suite 232, Washington, DC 20016', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style inline-grey noprint', id: 'NavQuickPayAccountSummary_button_3301NewMexicoAvenueNWSu' }] }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, scrollable: null, id: 'NavQuickPayAccountSummary_container_6', items: [ {xtype: 'button', text: '(202) 966-4811', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style subheaderPhoneNumber inline-grey noprint', id: 'NavQuickPayAccountSummary_button_2029664811' }] }] }] }, {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_3', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }, { xtype: 'panel', dock: 'top', frame: false, scrollable: 'true', id: 'panel_2', items: [ {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'mainContent MainContentWithHeaerAndSubheader ', scrollable: null, id: 'container_6', items: [ {xtype: 'container', flex: 1, scrollable: null, id: 'container_7', items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, name: 'FormAccountSummary', itemId: 'FormAccountSummary', cls: 'col-large-offSet-3 col-medium-offSet-3 col-small-offSet-1 smallTenColumn xsmallTwelveColumn mediumSixColumn largeSixColumn ', scrollable: null, id: 'FormAccountSummary', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_2' }, {xtype: 'instamedHeading1', text: 'Account Summary', id: 'FormAccountSummary_instamedHeading1' }, {xtype: 'container', margin: '24 0 0 0', scrollable: null, id: 'FormAccountSummary_container', items: [ {xtype: 'container', layout: {type: 'hbox'}, cls: 'MultipleFieldsContainer im-account-summary-form-section-information', scrollable: null, id: 'FormAccountSummary_container_1', plugins: 'responsive', responsiveConfig: {'width > 600':{layout : { type : 'hbox'},},'width <= 600':{layout : { type : 'vbox'},},}, items: [ {xtype: 'container', flex: 1, scrollable: null, id: 'FormAccountSummary_container_2', items: [ {xtype: 'label', html: '', name: 'PatientInformation', ui: 'light-subheading-primary', cls: 'light-subheading-primary', id: 'FormAccountSummary_PatientInformation' }, {xtype: 'label', html: 'Foxhall Podiatry Associates, PC', name: 'ProviderName', ui: 'body1-secondary', cls: 'im-account-summary-form-patientname body1-secondary', id: 'FormAccountSummary_ProviderName' }] }, {xtype: 'container', width: 24, name: 'ViewStatementAsOfContainerSpacer', cls: 'x-spacer', id: 'FormAccountSummary_ViewStatementAsOfContainerSpacer' }, {xtype: 'container', align: 'right', name: 'ViewStatementAsOfContainer', flex: 1, hidden: true, cls: 'im-view-statement-asof-component', scrollable: null, id: 'FormAccountSummary_ViewStatementAsOfContainer', items: [ {xtype: 'container', html: '', name: 'ViewStatementLinkContainer', cls: 'im-view-statement-link im-view-statement-asof-component-link', scrollable: null, id: 'FormAccountSummary_ViewStatementLinkContainer' }, {xtype: 'label', html: '', name: 'AsOfDate', ui: 'body1-secondary', cls: 'im-view-statement-asof-component-asof body1-secondary', id: 'FormAccountSummary_AsOfDate' }] }] }] }, {xtype: 'container', margin: '24 0 0 0', cls: 'im-account-summary-form-section-graph', scrollable: null, id: 'FormAccountSummary_container_3', items: [ {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'FormAccountSummary_container_4', plugins: 'responsive', responsiveConfig: {'width > 600':{layout : { type : 'hbox'},},'width <= 600':{layout : { type : 'vbox'},},}, items: [ {xtype: 'container', scrollable: null, id: 'FormAccountSummary_container_5', items: [ {xtype: 'container', width: 180, height: 180, cls: 'im-centered-content-donut-chart', scrollable: null, id: 'FormAccountSummary_container_6', items: [ {xtype: 'container', centered: true, cls: 'im-center-text-wrapper', scrollable: null, id: 'FormAccountSummary_container_7', items: [ {xtype: 'container', html: 'Total Balance', name: 'AccountSummaryChartCenterText', scrollable: null, id: 'FormAccountSummary_AccountSummaryChartCenterText' }] }, {xtype: 'polar', reference: 'chart', flipXY: false, theme: 'instamed', store: Ext.data.StoreManager.lookup('AccountSummaryPaymentInformationStore'),axes:[],series:[{type: 'pie', angleField: 'Angle', donut: 90,label:{display: 'none',field: 'Label'},subStyle:{lineWidth: 0,strokeStyle: 'none'}, renderer: function (sprite, config, rendererData, index) { var colorsObject = {}, rendererObject = {}, output = {};colorsObject.fillStyle = this.getTheme().getColors()[index];;var renderer = function (sprite, config, renderedData, index) { return { fill: renderedData.store.getData().items[index].data.Color }; };rendererObject = renderer.apply(this, arguments);;return Ext.merge({}, colorsObject, rendererObject); },yField:[],tooltip:{renderer: function (tooltip, record, item) { if(record){ var label = record.get('Label'); var isMaxAngle = record.get('IsMaxAngle'); var angle = record.get('Angle'); if(label & angle && isMaxAngle) { tooltip.setHtml(label + ' : ' + Ext.util.Format.currency(isMaxAngle.toLowerCase() === 'true' ? 0 : angle)); } } },trackMouse: true}}], width: 180, height: 180, cls: 'im-chart im-chart-polar', id: 'FormAccountSummary_polar' }] }] }, {xtype: 'container', flex: 2, cls: 'im-account-summary-legend', scrollable: null, id: 'FormAccountSummary_container_8', items: [ {xtype: 'container', cls: 'im-account-summary-legend-centered', scrollable: null, id: 'FormAccountSummary_container_9', items: [ {xtype: 'instameddisplayfield', fieldLabel: 'Total Charges', label: 'Total Charges', readOnly: true, hidden: true, labelSeparator: ' ', value: '-', required: false, labelWrap: true, labelWidth: 'auto', labelAlign: 'left', errorTarget: 'under', clearable: false, requiredMessage: 'Total Charges is required', autoComplete: 'on', name: 'TotalCharges', margin: '', ariaRole: '', cls: 'im-display-field im-legend-label im-legend-label-disable-custom-color im-legend-label-empty mod-rounded', id: 'FormAccountSummary_TotalCharges', plugins: 'responsive', responsiveConfig: {'width < 600':{labelAlign : 'top',},'width >= 600':{labelAlign : 'left',},}, listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'instameddisplayfield', fieldLabel: 'Insurance & Adjustments', label: 'Insurance & Adjustments', readOnly: true, hidden: true, labelSeparator: ' ', value: '-', required: false, labelWrap: true, labelWidth: 'auto', labelAlign: 'left', errorTarget: 'under', clearable: false, requiredMessage: 'Insurance & Adjustments is required', autoComplete: 'on', name: 'InsuranceAdjustments', margin: '', ariaRole: '', cls: 'im-display-field im-legend-label im-legend-label-disable-custom-color im-legend-label-grey-400 mod-rounded', id: 'FormAccountSummary_InsuranceAdjustments', plugins: 'responsive', responsiveConfig: {'width < 600':{labelAlign : 'top',},'width >= 600':{labelAlign : 'left',},}, listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'instameddisplayfield', fieldLabel: 'Previously Paid', label: 'Previously Paid', readOnly: true, hidden: true, labelSeparator: ' ', value: '-', required: false, labelWrap: true, labelWidth: 'auto', labelAlign: 'left', errorTarget: 'under', clearable: false, requiredMessage: 'Previously Paid is required', autoComplete: 'on', name: 'PreviouslyPaid', margin: '', ariaRole: '', cls: 'im-display-field im-legend-label im-legend-label-disable-custom-color im-legend-label-primary-green mod-rounded', id: 'FormAccountSummary_PreviouslyPaid', plugins: 'responsive', responsiveConfig: {'width < 600':{labelAlign : 'top',},'width >= 600':{labelAlign : 'left',},}, listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', name: 'AccountSummaryLegendTotalBalanceDivider', hidden: true, cls: 'im-account-summary-legend-total-balance-divider', scrollable: null, id: 'FormAccountSummary_AccountSummaryLegendTotalBalanceDivider' }, {xtype: 'instameddisplayfield', fieldLabel: 'Balance', label: 'Balance', readOnly: true, hidden: false, labelSeparator: ' ', value: '', required: false, labelWrap: true, labelWidth: 'auto', labelAlign: 'left', errorTarget: 'under', clearable: false, requiredMessage: 'Balance is required', autoComplete: 'on', name: 'PatientBalance', margin: '', ariaRole: '', cls: 'im-display-field im-legend-label im-legend-label-disable-custom-color im-legend-label-primary-blue-500 mod-title-blue-500-value mod-rounded', id: 'FormAccountSummary_PatientBalance', plugins: 'responsive', responsiveConfig: {'width < 600':{labelAlign : 'top',},'width >= 600':{labelAlign : 'left',},}, listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'instameddisplayfield', fieldLabel: 'Pending Payments', label: 'Pending Payments', readOnly: true, hidden: true, labelSeparator: ' ', value: '(- $0.00)', required: false, labelWrap: true, labelWidth: 'auto', labelAlign: 'left', errorTarget: 'under', clearable: false, requiredMessage: 'Pending Payments is required', autoComplete: 'on', name: 'PendingPayments', margin: '', ariaRole: '', cls: 'im-display-field im-legend-label im-legend-label-disable-custom-color im-legend-label-value-stroked mod-rounded', id: 'FormAccountSummary_PendingPayments', plugins: 'responsive', responsiveConfig: {'width < 600':{labelAlign : 'top',},'width >= 600':{labelAlign : 'left',},}, listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'instameddisplayfield', fieldLabel: 'Payment Amount', label: 'Payment Amount', readOnly: true, hidden: true, labelSeparator: ' ', value: '', required: false, labelWrap: true, labelWidth: 'auto', labelAlign: 'left', errorTarget: 'under', clearable: false, requiredMessage: 'Payment Amount is required', autoComplete: 'on', name: 'PaymentAmount', margin: '', ariaRole: '', cls: 'im-display-field im-legend-label im-legend-label-disable-custom-color im-legend-label-value-blue mod-rounded', id: 'FormAccountSummary_PaymentAmount', plugins: 'responsive', responsiveConfig: {'width < 600':{labelAlign : 'top',},'width >= 600':{labelAlign : 'left',},}, listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', cls: 'im-account-summary-form-section-detailslink', scrollable: null, id: 'FormAccountSummary_container_10', items: [ {xtype: 'button', text: 'View Details', name: 'AccountSummaryShow', ui: 'inline-hyperlink', margin: '', ariaRole: 'button', cls: 'x-button-link-style inline-hyperlink noprint', id: 'FormAccountSummary_button_ViewDetails', listeners: {tap: function(cmp, event) { event.preventDefault();InstaMed.get('MoreDetailsContainer').show(); InstaMed.get('AccountSummaryHide').show(); InstaMed.get('AccountSummaryShow').hide(); }} }, {xtype: 'button', text: 'Hide Details', name: 'AccountSummaryHide', ui: 'inline-hyperlink', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style inline-hyperlink noprint', id: 'FormAccountSummary_button_HideDetails', listeners: {tap: function(cmp, event) { event.preventDefault();InstaMed.get('AccountSummaryShow').show(); InstaMed.get('AccountSummaryHide').hide(); InstaMed.get('MoreDetailsContainer').hide(); }} }] }] }] }] }] }, {xtype: 'container', name: 'MoreDetailsContainer', margin: '16 0 16 0', hidden: true, cls: 'im-account-summary-form-section-details', scrollable: null, id: 'FormAccountSummary_MoreDetailsContainer', items: [ {xtype: 'container', layout: {type: 'float'}, cls: 'floatedContainer', scrollable: null, id: 'FormAccountSummary_container_11', items: [ {xtype: 'instameddisplayfield', fieldLabel: 'Patient Name', label: 'Patient Name', readOnly: true, labelSeparator: ' ', value: '', required: false, labelWrap: true, labelAlign: 'top', errorTarget: 'under', clearable: false, requiredMessage: 'Patient Name is required', autoComplete: 'on', name: 'PatientName', ui: 'payment-flow', margin: '', ariaRole: '', cls: 'im-display-field payment-flow', id: 'FormAccountSummary_PatientName', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'instameddisplayfield', fieldLabel: 'Guarantor Name', label: 'Guarantor Name', readOnly: true, hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'top', errorTarget: 'under', clearable: false, requiredMessage: 'Guarantor Name is required', autoComplete: 'on', name: 'GuarantorName', ui: 'payment-flow', margin: '', ariaRole: '', cls: 'im-display-field payment-flow', id: 'FormAccountSummary_GuarantorName', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'instameddisplayfield', fieldLabel: 'Patient ID', label: 'Patient ID', readOnly: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'top', errorTarget: 'under', clearable: false, requiredMessage: 'Patient ID is required', autoComplete: 'on', name: 'PatientID', ui: 'payment-flow', margin: '', ariaRole: '', cls: 'im-display-field payment-flow', id: 'FormAccountSummary_PatientID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'instameddisplayfield', fieldLabel: 'Birth Date', label: 'Birth Date', readOnly: true, hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'top', errorTarget: 'under', clearable: false, requiredMessage: 'Birth Date is required', autoComplete: 'on', name: 'PatientBirthDate', ui: 'payment-flow', margin: '', ariaRole: '', cls: 'im-display-field payment-flow', id: 'FormAccountSummary_PatientBirthDate', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }] }] }, {xtype: 'hiddenfield', fieldLabel: 'StatementID', label: 'StatementID', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'StatementID is required', autoComplete: 'on', name: 'StatementID', margin: '', id: 'FormAccountSummary_StatementID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, cls: 'buttonContainer', scrollable: null, id: 'FormAccountSummary_container_12', items: [ {xtype: 'spacer', id: 'FormAccountSummary_spacer' }, {xtype: 'button', text: 'Back', name: 'btnBack', ui: 'secondary', margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'FormAccountSummary_button_Back', listeners: {tap: function() { PerformAction({}, QuickPayPatientEntryController.navigateBack,null); }} }, {xtype: 'button', text: 'Pay Over Time', name: 'PayOverTime', ui: 'secondary', margin: '', hidden: true, ariaRole: 'button', cls: 'secondary noprint', id: 'FormAccountSummary_button_PayOverTime', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),QuickPayAccountSummaryController.payOverTime,cmp,undefined,undefined,undefined,undefined,undefined); }} }, {xtype: 'button', text: 'Pay Now', name: 'PayNow', ui: 'action', margin: '', ariaRole: 'button', cls: 'action noprint', id: 'FormAccountSummary_button_PayNow', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),QuickPayAccountSummaryController.payNow,cmp,undefined,undefined,undefined,undefined,undefined); }} }] }] }] }] }] }, {xtype: 'spacer', flex: 1, id: 'spacer_6' }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, cls: 'x-panel-footer im-powered-by', scrollable: null, id: 'container_8', items: [ {xtype: 'spacer', id: 'spacer_7' }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn ', scrollable: null, id: 'NavQuickPayAccountSummary_container_7', items: [ {xtype: 'image', name: 'poweredbylogo', cls: 'hidden hiddenxs hiddensm', id: 'NavQuickPayAccountSummary_poweredbylogo' }, {xtype: 'container', cls: 'copyrightContainer hiddenxs hiddensm', scrollable: null, id: 'NavQuickPayAccountSummary_container_8', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavQuickPayAccountSummary_spacer_4' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavQuickPayAccountSummary_button_copyrightFooter' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavQuickPayAccountSummary_spacer_5' }] }, {xtype: 'spacer', cls: 'hiddenxs hiddensm', id: 'NavQuickPayAccountSummary_spacer_6' }, {xtype: 'container', cls: 'linkButtonContainer hiddenxs hiddensm', scrollable: null, id: 'NavQuickPayAccountSummary_container_9', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_Security', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_Privacy', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_Terms', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_Help', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }, {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenxs hiddensm', id: 'menuitem_en_4'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenxs hiddensm', id: 'menuitem_es_4'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenxs hiddensm', id: 'menuitem_fr_4'},], name: 'ForeignLanguages', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_ForeignLanguages' }] }, {xtype: 'container', cls: 'hiddenmd hiddenlg', scrollable: null, id: 'NavQuickPayAccountSummary_container_10', items: [ {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavQuickPayAccountSummary_container_11', items: [ {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_7' }, {xtype: 'image', name: 'poweredbylogo', cls: 'hidden', id: 'NavQuickPayAccountSummary_poweredbylogo_1' }, {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_8' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavQuickPayAccountSummary_container_12', items: [ {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_9' }, {xtype: 'container', cls: 'copyrightContainer', scrollable: null, id: 'NavQuickPayAccountSummary_container_13', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavQuickPayAccountSummary_spacer_10' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavQuickPayAccountSummary_button_copyrightFooter_1' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavQuickPayAccountSummary_spacer_11' }] }, {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_12' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavQuickPayAccountSummary_container_14', items: [ {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_13' }, {xtype: 'container', cls: 'linkButtonContainer ', scrollable: null, id: 'NavQuickPayAccountSummary_container_15', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_Security_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_Privacy_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_Terms_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_Help_1', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }] }, {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_14' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavQuickPayAccountSummary_container_16', items: [ {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_15' }, {xtype: 'container', scrollable: null, id: 'NavQuickPayAccountSummary_container_17', items: [ {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenmd hiddenlg', id: 'menuitem_en_5'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenmd hiddenlg', id: 'menuitem_es_5'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenmd hiddenlg', id: 'menuitem_fr_5'},], name: 'ForeignLanguages', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavQuickPayAccountSummary_button_ForeignLanguages_1' }] }, {xtype: 'spacer', id: 'NavQuickPayAccountSummary_spacer_16' }] }] }] }, {xtype: 'spacer', id: 'spacer_8' }] }] }, {xtype: 'container', name: 'NavSelectProvider', layout: {type: 'vbox', pack: 'start'}, scrollable: 'true', id: 'NavSelectProvider', items: [ {xtype: 'container', docked: 'top', scrollable: null, id: 'NavSelectProvider_container', items: [ {xtype: 'instamedNavigationBar', name: 'headerBar', layout: {type: 'hbox'}, hidden: false, cls: 'im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavSelectProvider_headerBar', items: [ {xtype: 'spacer', id: 'NavSelectProvider_spacer', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'titlebar', title: '<a href=\\"../../Form/PaymentPortal/Start\\"> <img width=\\"101\\" height=\\"32\\" src=\\"../../Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry\\">', maxWidth: 1272, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavSelectProvider_titlebar', plugins: 'responsive', responsiveConfig: {'width >= 1272':{title :'',},'width < 1272':{title : ' ',},}, items: [ {xtype: 'button', accessibleText: 'Back', iconCls: 'x-ma ma-arrow-back', align: 'left', name: 'TitleBarNavigationViewBack', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-icon-link-style white hiddenlg noprint', id: 'NavSelectProvider_TitleBarNavigationViewBack', plugins: 'responsive', responsiveConfig: {'width > 1272':{iconCls :'',},'width <= 1272':{iconCls : 'x-ma ma-arrow-back',},}, listeners: {tap: function() { PerformAction({}, QuickPayPatientEntryController.navigateBack,null); }} }, {xtype: 'image', width: 127, height: 40, src: 'https://instamedprd.cachefly.net/V_2022_August/Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry', align: 'left', cls: 'x-clickable x-image-size-contain', id: 'NavSelectProvider_image', plugins: 'responsive', responsiveConfig: {'width >= 1272':{hidden : false,},'width < 1272':{hidden :true,},}, listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Start'; }} }, {xtype: 'button', name: 'HeaderTitlebarButton', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style im-center-header-button white noprint', id: 'NavSelectProvider_HeaderTitlebarButton' }, {xtype: 'button', text: 'Pay Any Healthcare Bill', align: 'right', name: 'PayAnyHealthcareBillButton', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style x-border hiddenxs hiddensm white noprint', id: 'NavSelectProvider_button_PayAnyHealthcareBill', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?id=foxhallpodiatry&pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', text: 'Pay Bills', iconCls: 'x-ma ma-search', iconAlign: 'top', align: 'right', name: 'PayAnyHealthcareBillIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-ontop-link-style white hiddenmd hiddenlg noprint', id: 'NavSelectProvider_button_PayBills', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', accessibleText: 'Log In or Sign Up', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Log In', handler: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }, id: 'menuitem_LogIn_3'},{xtype: 'menuitem', text: 'Sign Up', handler: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }, id: 'menuitem_SignUp_3'},], name: 'LoginOrSignUpProfileIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavSelectProvider_button_LoginOrSignUpProfileIcon', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: true,},'!InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=LoginOrSignUpProfileIcon]')[0].getMenu().hide(); }} }, {xtype: 'button', text: '', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_6'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_6'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_6'},], name: 'Profile', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style white noprint', id: 'NavSelectProvider_button_Profile', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: false,},'InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=Profile]')[0].getMenu().hide(); }} }, {xtype: 'container', align: 'right', name: 'LoginOrSignUpContainer', layout: {type: 'hbox'}, scrollable: null, id: 'NavSelectProvider_LoginOrSignUpContainer', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: false,},'!InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, items: [ {xtype: 'button', text: 'Log In', align: 'right', name: 'LoginForDualLogin', ui: 'white', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavSelectProvider_button_LoginForDualLogin', listeners: {tap: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }} }, {xtype: 'label', html: 'or', align: 'right', name: 'Or', ui: 'body1-white', cls: 'hiddenxs hiddensm body1-white', id: 'NavSelectProvider_Or' }, {xtype: 'button', text: 'Sign Up', align: 'right', name: 'SignUpForDualLogin', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavSelectProvider_button_SignUpForDualLogin', listeners: {tap: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }} }] }, {xtype: 'button', accessibleText: 'Profile', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_7'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_7'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_7'},], name: 'ProfileIcon', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavSelectProvider_button_ProfileIcon', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: true,},'InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=ProfileIcon]')[0].getMenu().hide(); }} }] }, {xtype: 'spacer', id: 'NavSelectProvider_spacer_1', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }] }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'x-subheader-container', scrollable: null, id: 'NavSelectProvider_container_1', items: [ {xtype: 'spacer', id: 'NavSelectProvider_spacer_2', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn x-subheader-panel ', scrollable: null, id: 'NavSelectProvider_container_2', items: [ {xtype: 'button', text: 'FP', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style x-button-provider-logo grey noprint', id: 'NavSelectProvider_button_FP', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'vbox', pack: 'center', align: 'left'}, cls: 'im-provider-header-buttons', scrollable: null, id: 'NavSelectProvider_container_3', items: [ {xtype: 'button', text: 'Foxhall Podiatry Associates, PC', name: 'SubheaderProviderName', ui: 'inline-dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style im-bold-button inline-dark-grey noprint', id: 'NavSelectProvider_button_SubheaderProviderName', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'NavSelectProvider_container_4', items: [ {xtype: 'container', html: '', hidden: true, cls: 'im-address-verification-icon', scrollable: null, id: 'NavSelectProvider_container_5' }, {xtype: 'button', text: '3301 New Mexico Avenue, NW Suite 232, Washington, DC 20016', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style inline-grey noprint', id: 'NavSelectProvider_button_3301NewMexicoAvenueNWSuite232' }] }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, scrollable: null, id: 'NavSelectProvider_container_6', items: [ {xtype: 'button', text: '(202) 966-4811', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style subheaderPhoneNumber inline-grey noprint', id: 'NavSelectProvider_button_2029664811' }] }] }] }, {xtype: 'spacer', id: 'NavSelectProvider_spacer_3', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }, { xtype: 'panel', dock: 'top', frame: false, scrollable: 'true', id: 'panel_3', items: [ {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'mainContent MainContentWithHeaerAndSubheader ', scrollable: null, id: 'container_9', items: [ {xtype: 'container', flex: 1, scrollable: null, id: 'container_10', items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, name: 'MyFormPanel', itemId: 'MyFormPanel', cls: 'col-large-offSet-3 col-medium-offSet-3 col-small-offSet-1 smallTenColumn xsmallTwelveColumn mediumSixColumn largeSixColumn ', scrollable: null, id: 'MyFormPanel', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_3' }, {xtype: 'instamedHeading1', text: 'Select Healthcare Provider', id: 'MyFormPanel_instamedHeading1' }, {xtype: 'dataviewliteproviders', tpl: [' {AutoLogo:htmlEncode}{ProviderName:htmlEncode} {AutoLogo:htmlEncode}{ProviderName:htmlEncode} {ProviderName:htmlEncode}{ProviderName:htmlEncode}{ProviderFormatedAddress:htmlEncode}{ProviderName:htmlEncode}{ProviderAddress1:htmlEncode} Features This provider offers automatic payments, paperless billing, and payment plans. {GroupName:htmlEncode} {ProviderInitials:htmlEncode}{OffNetworkProviderName:htmlEncode}{OffNetworkProviderName:htmlEncode}{OffNetworkProviderAddress1:htmlEncode} {OffNetworkProviderAddress2:htmlEncode}, {OffNetworkProviderCity:htmlEncode} {OffNetworkProviderState:htmlEncode} {OffNetworkProviderZip:htmlEncode} Features This provider offers automatic payments, paperless billing, and payment plans. ',{isShow: function(group){return !(group == null || group == "")},isTrue: function(value){return (value == "True")},isInternal: function(isInternal){ return !(isInternal == null || isInternal == "True")} }], itemSelector: '.ma-more-vert', customClickEvent: function(element,event){ if(element.classList.contains('x-listpaging')){ Ext.fly(element).fireEvent('tap'); }else{ element & element.firstElementChild && element.firstElementChild.onkeydown && element.firstElementChild.onkeydown(event); } }, emptyText: '', deferEmptyText: false, deferInitialRefresh: false,store: Ext.data.StoreManager.lookup('MyAccountProvidersList-init'), name: 'ProviderBadgesProviderList', margin: '', cls: 'im-providers-dataview-search', inContextWidth: 800, id: 'MyFormPanel_ProviderBadgesProviderList' }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, cls: 'buttonContainer', scrollable: null, id: 'MyFormPanel_container', items: [ {xtype: 'spacer', id: 'MyFormPanel_spacer' }, {xtype: 'button', text: 'Back', name: 'btnBack', ui: 'secondary', margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'MyFormPanel_button_Back', listeners: {tap: function() { PerformAction({}, QuickPayPatientEntryController.navigateBack,null); }} }] }] }] }] }] }, {xtype: 'spacer', flex: 1, id: 'spacer_9' }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, cls: 'x-panel-footer im-powered-by', scrollable: null, id: 'container_11', items: [ {xtype: 'spacer', id: 'spacer_10' }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn ', scrollable: null, id: 'NavSelectProvider_container_7', items: [ {xtype: 'image', name: 'poweredbylogo', cls: 'hidden hiddenxs hiddensm', id: 'NavSelectProvider_poweredbylogo' }, {xtype: 'container', cls: 'copyrightContainer hiddenxs hiddensm', scrollable: null, id: 'NavSelectProvider_container_8', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavSelectProvider_spacer_4' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavSelectProvider_button_copyrightFooter' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavSelectProvider_spacer_5' }] }, {xtype: 'spacer', cls: 'hiddenxs hiddensm', id: 'NavSelectProvider_spacer_6' }, {xtype: 'container', cls: 'linkButtonContainer hiddenxs hiddensm', scrollable: null, id: 'NavSelectProvider_container_9', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_Security', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_Privacy', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_Terms', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_Help', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }, {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenxs hiddensm', id: 'menuitem_en_6'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenxs hiddensm', id: 'menuitem_es_6'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenxs hiddensm', id: 'menuitem_fr_6'},], name: 'ForeignLanguages', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_ForeignLanguages' }] }, {xtype: 'container', cls: 'hiddenmd hiddenlg', scrollable: null, id: 'NavSelectProvider_container_10', items: [ {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavSelectProvider_container_11', items: [ {xtype: 'spacer', id: 'NavSelectProvider_spacer_7' }, {xtype: 'image', name: 'poweredbylogo', cls: 'hidden', id: 'NavSelectProvider_poweredbylogo_1' }, {xtype: 'spacer', id: 'NavSelectProvider_spacer_8' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavSelectProvider_container_12', items: [ {xtype: 'spacer', id: 'NavSelectProvider_spacer_9' }, {xtype: 'container', cls: 'copyrightContainer', scrollable: null, id: 'NavSelectProvider_container_13', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavSelectProvider_spacer_10' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavSelectProvider_button_copyrightFooter_1' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavSelectProvider_spacer_11' }] }, {xtype: 'spacer', id: 'NavSelectProvider_spacer_12' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavSelectProvider_container_14', items: [ {xtype: 'spacer', id: 'NavSelectProvider_spacer_13' }, {xtype: 'container', cls: 'linkButtonContainer ', scrollable: null, id: 'NavSelectProvider_container_15', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_Security_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_Privacy_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_Terms_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_Help_1', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }] }, {xtype: 'spacer', id: 'NavSelectProvider_spacer_14' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavSelectProvider_container_16', items: [ {xtype: 'spacer', id: 'NavSelectProvider_spacer_15' }, {xtype: 'container', scrollable: null, id: 'NavSelectProvider_container_17', items: [ {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenmd hiddenlg', id: 'menuitem_en_7'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenmd hiddenlg', id: 'menuitem_es_7'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenmd hiddenlg', id: 'menuitem_fr_7'},], name: 'ForeignLanguages', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavSelectProvider_button_ForeignLanguages_1' }] }, {xtype: 'spacer', id: 'NavSelectProvider_spacer_16' }] }] }] }, {xtype: 'spacer', id: 'spacer_11' }] }] }, { xtype: 'window', title: 'What is Automatic Payment?', titleAlign: 'center', itemId: 'APCAboutWindow', flex: 1, defaultFocus: 'tool', closable: true, modal: true, draggable: false, constrainHeader: true, constrainTo: 'mainBorderPanel', closeAction: 'hide', name: 'APCAboutWindow', ui: 'large', maxWidth: 600, flex: 1, cls: 'large', id: 'APCAboutWindow', listeners: {show: function(cmp) { Ext.each(Ext.DomQuery.select('.x-panel-body', Ext.DomQuery.selectNode('.x-window[id=APCAboutWindow]')), function(p) { Ext.get(p.id).scrollTo('top', 0); }); }}, items: [ {xtype: 'label', html: 'Automatic Payments is a feature that notifies you of future balances and automatically schedules a payment for your balance up to your Automatic Payment Limit. \r\n\r\n Q: Which payment method will be used for the scheduled payment?\r\n A: The automatically scheduled payment will be charged to the payment method you have on file. \r\n Q: What is an Automatic Payment Limit?\r\n A: The Automatic Payment Limit is the maximum amount a single payment will be scheduled for. If your new balance exceeds this amount, a payment will be scheduled for the maximum amount. This limit applies to each new balance. \r\n Q: Can I edit my Automatic Payments enrollment after I sign up? \r\n A: Yes, you can edit the maximum payment amount, payment method, or cancel your enrollment from this portal. \r\n Q: How will I be notified of future balances? \r\n A: A notification will be sent with your balance, the scheduled payment amount, and the date the payment is scheduled for. ', flex: 1, id: 'label' }] }, {xtype: 'container', name: 'NavReceiptPreview', layout: {type: 'vbox', pack: 'start'}, showBackButton: false, showMenuButton: false, scrollable: 'true', id: 'NavReceiptPreview', items: [ {xtype: 'container', docked: 'top', scrollable: null, id: 'NavReceiptPreview_container', items: [ {xtype: 'instamedNavigationBar', name: 'headerBar', layout: {type: 'hbox'}, hidden: false, cls: 'im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavReceiptPreview_headerBar', items: [ {xtype: 'spacer', id: 'NavReceiptPreview_spacer', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'titlebar', title: '<a href=\\"../../Form/PaymentPortal/Start\\"> <img width=\\"101\\" height=\\"32\\" src=\\"../../Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry\\">', maxWidth: 1272, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavReceiptPreview_titlebar', plugins: 'responsive', responsiveConfig: {'width >= 1272':{title :'',},'width < 1272':{title : ' ',},}, items: [ {xtype: 'button', accessibleText: 'Back', iconCls: 'x-ma ma-arrow-back', align: 'left', name: 'TitleBarNavigationViewBack', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-icon-link-style white hiddenlg noprint', id: 'NavReceiptPreview_TitleBarNavigationViewBack', plugins: 'responsive', responsiveConfig: {'width > 1272':{iconCls :'',},'width <= 1272':{iconCls : 'x-ma ma-arrow-back',},}, listeners: {tap: function(){ headerPatientPortalBack(); }} }, {xtype: 'image', width: 127, height: 40, src: 'https://instamedprd.cachefly.net/V_2022_August/Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry', align: 'left', cls: 'x-clickable x-image-size-contain', id: 'NavReceiptPreview_image', plugins: 'responsive', responsiveConfig: {'width >= 1272':{hidden : false,},'width < 1272':{hidden :true,},}, listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Start'; }} }, {xtype: 'button', name: 'HeaderTitlebarButton', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style im-center-header-button white noprint', id: 'NavReceiptPreview_HeaderTitlebarButton' }, {xtype: 'button', text: 'Pay Any Healthcare Bill', align: 'right', name: 'PayAnyHealthcareBillButton', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style x-border hiddenxs hiddensm white noprint', id: 'NavReceiptPreview_button_PayAnyHealthcareBill', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?id=foxhallpodiatry&pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', text: 'Pay Bills', iconCls: 'x-ma ma-search', iconAlign: 'top', align: 'right', name: 'PayAnyHealthcareBillIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-ontop-link-style white hiddenmd hiddenlg noprint', id: 'NavReceiptPreview_button_PayBills', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', accessibleText: 'Log In or Sign Up', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Log In', handler: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }, id: 'menuitem_LogIn_16'},{xtype: 'menuitem', text: 'Sign Up', handler: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }, id: 'menuitem_SignUp_16'},], name: 'LoginOrSignUpProfileIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavReceiptPreview_button_LoginOrSignUpProfileIcon', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: true,},'!InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=LoginOrSignUpProfileIcon]')[0].getMenu().hide(); }} }, {xtype: 'button', text: '', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_32'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_32'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_32'},], name: 'Profile', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style white noprint', id: 'NavReceiptPreview_button_Profile', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: false,},'InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=Profile]')[0].getMenu().hide(); }} }, {xtype: 'container', align: 'right', name: 'LoginOrSignUpContainer', layout: {type: 'hbox'}, scrollable: null, id: 'NavReceiptPreview_LoginOrSignUpContainer', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: false,},'!InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, items: [ {xtype: 'button', text: 'Log In', align: 'right', name: 'LoginForDualLogin', ui: 'white', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavReceiptPreview_button_LoginForDualLogin', listeners: {tap: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }} }, {xtype: 'label', html: 'or', align: 'right', name: 'Or', ui: 'body1-white', cls: 'hiddenxs hiddensm body1-white', id: 'NavReceiptPreview_Or' }, {xtype: 'button', text: 'Sign Up', align: 'right', name: 'SignUpForDualLogin', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavReceiptPreview_button_SignUpForDualLogin', listeners: {tap: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }} }] }, {xtype: 'button', accessibleText: 'Profile', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_33'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_33'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_33'},], name: 'ProfileIcon', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavReceiptPreview_button_ProfileIcon', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: true,},'InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=ProfileIcon]')[0].getMenu().hide(); }} }] }, {xtype: 'spacer', id: 'NavReceiptPreview_spacer_1', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }] }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'x-subheader-container', scrollable: null, id: 'NavReceiptPreview_container_1', items: [ {xtype: 'spacer', id: 'NavReceiptPreview_spacer_2', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn x-subheader-panel ', scrollable: null, id: 'NavReceiptPreview_container_2', items: [ {xtype: 'button', text: 'FP', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style x-button-provider-logo grey noprint', id: 'NavReceiptPreview_button_FP', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'vbox', pack: 'center', align: 'left'}, cls: 'im-provider-header-buttons', scrollable: null, id: 'NavReceiptPreview_container_3', items: [ {xtype: 'button', text: 'Foxhall Podiatry Associates, PC', name: 'SubheaderProviderName', ui: 'inline-dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style im-bold-button inline-dark-grey noprint', id: 'NavReceiptPreview_button_SubheaderProviderName', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'NavReceiptPreview_container_4', items: [ {xtype: 'container', html: '', hidden: true, cls: 'im-address-verification-icon', scrollable: null, id: 'NavReceiptPreview_container_5' }, {xtype: 'button', text: '3301 New Mexico Avenue, NW Suite 232, Washington, DC 20016', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style inline-grey noprint', id: 'NavReceiptPreview_button_3301NewMexicoAvenueNWSuite232' }] }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, scrollable: null, id: 'NavReceiptPreview_container_6', items: [ {xtype: 'button', text: '(202) 966-4811', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style subheaderPhoneNumber inline-grey noprint', id: 'NavReceiptPreview_button_2029664811' }] }] }] }, {xtype: 'spacer', id: 'NavReceiptPreview_spacer_3', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }, { xtype: 'panel', dock: 'top', frame: false, scrollable: 'true', id: 'panel_16', items: [ {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'mainContent MainContentWithHeaerAndSubheader ', scrollable: null, id: 'container_51', items: [ {xtype: 'container', flex: 1, scrollable: null, id: 'container_52', items: [ {xtype: 'container', cls: 'col-large-offSet-3 col-medium-offSet-3 col-small-offSet-1 smallTenColumn xsmallTwelveColumn mediumSixColumn largeSixColumn reverse im-form-wrapper', scrollable: null, id: 'container_53', items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, defaultSubmitButton: 'Verify', name: 'TextMsgEnrollTile', itemId: 'TextMsgEnrollTile', cls: 'bottom-pad-20', scrollable: null, id: 'TextMsgEnrollTile', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_17' }, {xtype: 'button', iconCls: 'md-icon-close', name: 'HideContainerX', ui: 'grey', margin: '', ariaRole: 'button', cls: 'container-x-closebutton grey noprint', id: 'TextMsgEnrollTile_HideContainerX', listeners: {tap: function(cmp) { var cmpForm = InstaMed.findParentForm(cmp); var containerToHide = Ext.getCmp('TextMsgEnrollTile'); if(containerToHide, cmpForm) { containerToHide.setVisible(false); }}} }, {xtype: 'container', name: 'TextMsgEnroll', flex: 2, scrollable: null, id: 'TextMsgEnrollTile_TextMsgEnroll', items: [ {xtype: 'instamedHeading1', text: 'Keep Your Account Safe and Updated', id: 'TextMsgEnrollTile_instamedHeading1' }, {xtype: 'container', html: 'To increase your security, please verify your mobile phone number. Add Number\r\n You can use this to reset passwords, enable two-step verification and \r\n enroll in payment alerts via text message.', name: 'TextMsgTwoStepFactorAndText', hidden: true, cls: 'im-form-bodytext', scrollable: null, id: 'TextMsgEnrollTile_TextMsgTwoStepFactorAndText' }, {xtype: 'container', html: 'To increase your security, please add and verify your mobile phone number. Add Number \r\n You can use this to reset passwords and enable two-step verification.', name: 'TextMsgTwoStepFactorOnly', hidden: false, cls: 'im-form-bodytext', scrollable: null, id: 'TextMsgEnrollTile_TextMsgTwoStepFactorOnly' }, {xtype: 'textfield', maxLength: 14, maxLength: 14, enforceMaxLength: true, minLength: 10, selectOnFocus: true, autoCorrect: false, fieldLabel: 'TextEnrollPhoneNumber', label: 'TextEnrollPhoneNumber', component: {"type":"tel","pattern":null}, inputType: 'tel', hidden: true, labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'TextEnrollPhoneNumber is required', autoComplete: 'on', name: 'TextEnrollPhoneNumber', margin: '', id: 'TextMsgEnrollTile_TextEnrollPhoneNumber', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}},change: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null & s != '') { s = s.replace(/[-,()\s]/g,'');var newValue='(';newValue+=s.substring(0,3);if(s.length>3){newValue+=') ';}newValue+=s.substring(3,6);if(s.length>6){newValue+='-';}newValue+=s.substring(6,10); if(isNaN(parseInt(newValue.substring(1,3)))){ newValue = ''; } field.setValue(newValue); if(InstaMed.isResponsive){ field.setInputValue(newValue); } } }} }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, cls: 'ppp-button-group', scrollable: null, id: 'TextMsgEnrollTile_container', items: [ {xtype: 'button', text: 'Verify', name: 'Verify', ui: 'action', margin: '', ariaRole: 'button', cls: 'action noprint', id: 'TextMsgEnrollTile_button_Verify', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),TextMessageEnrollmentController.sendEnrollmentText,cmp,undefined,undefined,undefined,undefined,undefined); }} }, {xtype: 'button', text: 'No, Thanks', name: 'NoThanks', ui: 'secondary', margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'TextMsgEnrollTile_button_NoThanks', listeners: {tap: function(cmp) { if (cmp) { var containerToHide = Ext.getCmp('TextMsgEnrollTile'); containerToHide.setVisible(false); }}} }] }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'TextMsgEnrollTile_container_1', items: [ {xtype: 'checkboxfield', value: 'true', uncheckedValue: 'false', checked: true, labelFieldComponentName: 'LabelEnableTwoStepVerification', fieldLabel: '', label: '', labelSeparator: ' ', required: false, labelWrap: true, labelAlign: 'right', errorTarget: 'under', clearable: false, requiredMessage: ' is required', autoComplete: 'on', name: 'EnableTwoStepVerification', hideLabel: true, margin: '', id: 'TextMsgEnrollTile_EnableTwoStepVerification', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'container', html: 'Enable Two-Step Verification', name: 'LabelEnableTwoStepVerification', cls: 'im-checkbox-label im-checkbox-label-single-field-form ', scrollable: null, id: 'TextMsgEnrollTile_LabelEnableTwoStepVerification' }] }, {xtype: 'container', html: 'By enrolling in two-step verification and/or text alerts, you agree to all InstaMed Communications\r\n Terms and Conditions. InstaMed will only use this number for account security and payment alerts. Message and data rates may apply.', name: 'TextMsgTwoStepTermsClause', cls: 'im-form-bodytext', scrollable: null, id: 'TextMsgEnrollTile_TextMsgTwoStepTermsClause' }] }, {xtype: 'container', name: 'TextMsgConfirmation', flex: 2, hidden: true, scrollable: null, id: 'TextMsgEnrollTile_TextMsgConfirmation', items: [ {xtype: 'instamedHeading1', text: 'Please Complete Verification', id: 'TextMsgEnrollTile_instamedHeading1_1' }, {xtype: 'container', html: 'Use the link in the text we just sent to complete verification. Once verified, you can go to preferences to manage your security and text message settings.', name: 'TextMsgEnrollVerifyDescription', cls: 'im-form-bodytext', scrollable: null, id: 'TextMsgEnrollTile_TextMsgEnrollVerifyDescription' }] }] }, { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, name: 'FormPaymentReceipt', itemId: 'FormPaymentReceipt', showBackButton: false, scrollable: null, id: 'FormPaymentReceipt', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_18' }, {xtype: 'instamedHeading1', text: 'Payment Summary', id: 'FormPaymentReceipt_instamedHeading1' }, {xtype: 'container', name: 'PaymentPlanContainer', hidden: true, cls: 'im-dataview-tile im-dataview-tile-relative im-dataview-tile-payment-plan mod-is-selectable mod-is-not-selectable', scrollable: null, id: 'FormPaymentReceipt_PaymentPlanContainer', items: [ {xtype: 'container', layout: {type: 'hbox'}, cls: 'im-dataview-tile-container', scrollable: null, id: 'FormPaymentReceipt_container', items: [ {xtype: 'container', name: 'PaymentPlanStatus', cls: 'im-dataview-tile-select-item', scrollable: null, id: 'FormPaymentReceipt_PaymentPlanStatus' }, {xtype: 'container', cls: 'im-dataview-tile-content', scrollable: null, id: 'FormPaymentReceipt_container_1', items: [ {xtype: 'label', name: 'PaymentPlanInstallment', cls: 'im-dataview-text-label', id: 'FormPaymentReceipt_PaymentPlanInstallment' }, {xtype: 'label', name: 'PaymentPlanDuration', ui: 'body1-secondary', cls: 'im-dataview-text-value x-show-block body1-secondary', id: 'FormPaymentReceipt_PaymentPlanDuration' }, {xtype: 'label', name: 'PaymentPlanStartDate', ui: 'body1-secondary', cls: 'im-dataview-text-value x-show-block body1-secondary', id: 'FormPaymentReceipt_PaymentPlanStartDate' }, {xtype: 'label', name: 'PaymentPlanInitialPaymentStatus', ui: 'body1-secondary', cls: 'im-dataview-text-value x-show-block body1-secondary', id: 'FormPaymentReceipt_PaymentPlanInitialPaymentStatus' }] }] }] }, {xtype: 'container', cls: 'im-transaction-status-wrapper', scrollable: null, id: 'FormPaymentReceipt_container_2', items: [ {xtype: 'container', name: 'TransactionStatusResponseMessage', layout: {type: 'hbox'}, hidden: false, cls: 'im-transaction-status-container', scrollable: null, id: 'FormPaymentReceipt_TransactionStatusResponseMessage', items: [ {xtype: 'container', name: 'htmlTransactionStatusResponseMessage', scrollable: null, id: 'FormPaymentReceipt_htmlTransactionStatusResponseMessage' }, {xtype: 'label', name: 'labelTransactionStatusResponseMessage', ui: 'light-subheading-primary', cls: 'light-subheading-primary', id: 'FormPaymentReceipt_labelTransactionStatusResponseMessage' }] }, {xtype: 'container', name: 'TransactionStatusAPC', layout: {type: 'hbox'}, hidden: true, cls: 'im-transaction-status-container', scrollable: null, id: 'FormPaymentReceipt_TransactionStatusAPC', items: [ {xtype: 'container', name: 'htmlTransactionStatusAPC', scrollable: null, id: 'FormPaymentReceipt_htmlTransactionStatusAPC' }, {xtype: 'label', name: 'labelTransactionStatusAPC', ui: 'light-subheading-primary', cls: 'light-subheading-primary', id: 'FormPaymentReceipt_labelTransactionStatusAPC' }] }, {xtype: 'container', name: 'TransactionEStatement', layout: {type: 'hbox'}, hidden: true, cls: 'im-transaction-status-container', scrollable: null, id: 'FormPaymentReceipt_TransactionEStatement', items: [ {xtype: 'container', name: 'htmlTransactionEStatement', scrollable: null, id: 'FormPaymentReceipt_htmlTransactionEStatement' }, {xtype: 'label', name: 'labelTransactionEStatement', ui: 'light-subheading-primary', cls: 'light-subheading-primary', id: 'FormPaymentReceipt_labelTransactionEStatement' }] }, {xtype: 'container', name: 'InitialPayment', layout: {type: 'hbox'}, hidden: true, cls: 'im-transaction-status-container', scrollable: null, id: 'FormPaymentReceipt_InitialPayment', items: [ {xtype: 'container', name: 'htmlInitialPayment', scrollable: null, id: 'FormPaymentReceipt_htmlInitialPayment' }, {xtype: 'label', name: 'labelInitialPayment', ui: 'light-subheading-primary', cls: 'light-subheading-primary', id: 'FormPaymentReceipt_labelInitialPayment' }] }, {xtype: 'container', name: 'PaymentPlanPrint', layout: {type: 'hbox'}, hidden: true, cls: 'im-transaction-status-container', scrollable: null, id: 'FormPaymentReceipt_PaymentPlanPrint', items: [ {xtype: 'container', name: 'htmlPaymentPlanPrint', scrollable: null, id: 'FormPaymentReceipt_htmlPaymentPlanPrint' }, {xtype: 'label', name: 'labelPaymentPlanPrint', ui: 'light-subheading-primary', cls: 'light-subheading-primary', id: 'FormPaymentReceipt_labelPaymentPlanPrint' }] }] }, {xtype: 'container', name: 'PatientPaymentConfirmHeaderContainer', cls: 'x-payment-header-container', scrollable: null, id: 'FormPaymentReceipt_PatientPaymentConfirmHeaderContainer', items: [ {xtype: 'instamedHeading1', name: '', hidden: true, id: 'FormPaymentReceipt_instamedHeading1_1' }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'FormPaymentReceipt_container_3', items: [ {xtype: 'label', align: 'left', name: 'PatientPaymentConfirmHeaderMessage', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_PatientPaymentConfirmHeaderMessage' }] }, {xtype: 'label', align: 'left', name: 'TransactionMessage', ui: 'body2-secondary', hidden: true, cls: 'x-label-payment-header body2-secondary', id: 'FormPaymentReceipt_TransactionMessage' }] }, {xtype: 'label', html: 'Your request for eStatement Enrollment has been sent. If you prefer to receive statements by mail, you can update your Statement Delivery Settings.', name: 'eStatementDelivery', ui: 'body1-primary', hidden: true, cls: 'im-bottom-label body1-primary', id: 'FormPaymentReceipt_eStatementDelivery' }, {xtype: 'container', hidden: true, cls: 'im-subtitle-container', scrollable: null, id: 'FormPaymentReceipt_container_4', items: [ {xtype: 'label', html: 'Provider Information', ui: 'body2-secondary', cls: 'im-subtitle-header body2-secondary', id: 'FormPaymentReceipt_label' }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'im-editable-provider-info', scrollable: null, id: 'FormPaymentReceipt_container_5', items: [ {xtype: 'container', scrollable: null, id: 'FormPaymentReceipt_container_6', items: [ {xtype: 'label', name: 'ProviderName', ui: 'light-subheading-primary', cls: 'light-subheading-primary', id: 'FormPaymentReceipt_ProviderName' }, {xtype: 'label', name: 'ProviderAddress', ui: 'body1-secondary', cls: 'body1-secondary', id: 'FormPaymentReceipt_ProviderAddress' }, {xtype: 'label', name: 'PayeePhoneNumber', ui: 'body1-secondary', cls: 'body1-secondary', id: 'FormPaymentReceipt_PayeePhoneNumber' }] }] }] }, {xtype: 'container', name: 'PatientInformationContainer', cls: 'im-subtitle-container', scrollable: null, id: 'FormPaymentReceipt_PatientInformationContainer', items: [ {xtype: 'label', html: 'Patient Information', ui: 'body2-secondary', cls: 'im-subtitle-header body2-secondary', id: 'FormPaymentReceipt_label_1' }, {xtype: 'dataviewlite', tpl: ['', '', '', '', '{PatientFirstName:htmlEncode} ', '{PatientLastName:htmlEncode} ', '({PatientID:htmlEncode})', '', '', '', '${Amount:htmlEncode}', '', '','', '', '', '', '{PatientFirstName:htmlEncode} ', '{PatientLastName:htmlEncode} ', '', '', '', '${Amount:htmlEncode}', '', '','', '',, '' ], itemSelector: '.patientItem', emptyText: '', deferInitialRefresh: false,store: Ext.data.StoreManager.lookup('PatientPaymentConfirmMultiARDataViewstore'), name: 'PatientPaymentConfirmMultiARDataView', id: 'FormPaymentReceipt_PatientPaymentConfirmMultiARDataView' }] }, {xtype: 'container', cls: 'im-subtitle-container', scrollable: null, id: 'FormPaymentReceipt_container_7', items: [ {xtype: 'label', html: 'Payment Method', ui: 'body2-secondary', cls: 'im-subtitle-header body2-secondary', id: 'FormPaymentReceipt_label_2' }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'im-editable-payment-info', scrollable: null, id: 'FormPaymentReceipt_container_8', items: [ {xtype: 'container', name: 'PaymentType', scrollable: null, id: 'FormPaymentReceipt_PaymentType' }, {xtype: 'container', scrollable: null, id: 'FormPaymentReceipt_container_9', items: [ {xtype: 'label', name: 'CardHolderName', ui: 'subheading-primary', hidden: true, cls: 'subheading-primary', id: 'FormPaymentReceipt_CardHolderName' }, {xtype: 'label', name: 'CheckingAccountHolderName', ui: 'subheading-primary', hidden: true, cls: 'subheading-primary', id: 'FormPaymentReceipt_CheckingAccountHolderName' }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'FormPaymentReceipt_container_10', items: [ {xtype: 'label', html: 'Ending in ', name: 'CreditCardNumber', ui: 'body1-secondary', hidden: true, cls: 'body1-secondary', id: 'FormPaymentReceipt_CreditCardNumber' }, {xtype: 'label', html: 'Ending in ', name: 'AccountNumber', ui: 'body1-secondary', hidden: true, cls: 'body1-secondary', id: 'FormPaymentReceipt_AccountNumber' }, {xtype: 'label', html: '', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_label_3' }, {xtype: 'label', html: '(Exp: )', name: 'ExpDate', ui: 'body1-secondary', hidden: true, cls: 'body1-secondary', id: 'FormPaymentReceipt_ExpDate' }, {xtype: 'label', html: '()', name: 'RoutingNumber', ui: 'body1-secondary', hidden: true, cls: 'body1-secondary', id: 'FormPaymentReceipt_RoutingNumber' }] }, {xtype: 'container', name: 'AdditionalPaymentReceiptContainer', hidden: true, scrollable: null, id: 'FormPaymentReceipt_AdditionalPaymentReceiptContainer', items: [ {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'FormPaymentReceipt_container_11', items: [ {xtype: 'label', html: 'Date:', ui: 'body1-secondary', cls: 'body1-secondary', id: 'FormPaymentReceipt_label_4' }, {xtype: 'label', html: '', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_label_5' }, {xtype: 'label', name: 'Date', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_Date' }] }, {xtype: 'container', name: 'AuthCodeContainer', layout: {type: 'hbox'}, scrollable: null, id: 'FormPaymentReceipt_AuthCodeContainer', items: [ {xtype: 'label', html: 'Auth. Code:', ui: 'body1-secondary', cls: 'body1-secondary', id: 'FormPaymentReceipt_label_6' }, {xtype: 'label', html: '', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_label_7' }, {xtype: 'label', name: 'AuthorizationCode', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_AuthorizationCode' }] }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'FormPaymentReceipt_container_12', items: [ {xtype: 'label', html: 'Response', ui: 'body1-secondary', cls: 'body1-secondary', id: 'FormPaymentReceipt_label_8' }, {xtype: 'label', html: ':', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_label_9' }, {xtype: 'label', name: 'ResponseCode', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_ResponseCode' }] }] }] }, {xtype: 'label', name: 'Amount', ui: 'subheading-primary', hidden: true, cls: 'subheading-primary', id: 'FormPaymentReceipt_Amount' }] }] }, {xtype: 'container', name: 'AutomaticPaymentInformationContainer', hidden: true, cls: 'im-subtitle-container', scrollable: null, id: 'FormPaymentReceipt_AutomaticPaymentInformationContainer', items: [ {xtype: 'label', html: 'Automatic Payments Information', ui: 'body2-secondary', cls: 'im-subtitle-header body2-secondary', id: 'FormPaymentReceipt_label_10' }, {xtype: 'container', name: 'AutomaticPaymentInformationContainer', cls: 'im-multiar-line-item', scrollable: null, id: 'FormPaymentReceipt_AutomaticPaymentInformationContainer_1', items: [ {xtype: 'container', scrollable: null, id: 'FormPaymentReceipt_container_13', items: [ {xtype: 'label', name: 'APCAmountText', ui: 'body1-primary', cls: 'im-multiar-patient body1-primary', id: 'FormPaymentReceipt_APCAmountText' }] }, {xtype: 'container', minHeight: 2, scrollable: null, id: 'FormPaymentReceipt_container_14' }, {xtype: 'container', scrollable: null, id: 'FormPaymentReceipt_container_15', items: [ {xtype: 'label', name: 'APCProcessDateText', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_APCProcessDateText' }] }, {xtype: 'container', name: 'APCProcessDateShortMonthWarningTextContainer', scrollable: null, id: 'FormPaymentReceipt_APCProcessDateShortMonthWarningTextContainer', items: [ {xtype: 'container', minHeight: 24, scrollable: null, id: 'FormPaymentReceipt_container_16' }, {xtype: 'label', name: 'APCProcessDateShortMonthWarningText', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_APCProcessDateShortMonthWarningText' }] }, {xtype: 'container', name: 'ScheduledPaymentsExplanationTextContainer', hidden: true, scrollable: null, id: 'FormPaymentReceipt_ScheduledPaymentsExplanationTextContainer', items: [ {xtype: 'container', minHeight: 24, scrollable: null, id: 'FormPaymentReceipt_container_17' }, {xtype: 'label', html: 'Note: The changes made to your automatic payment draft date will not apply to your currently scheduled payment but will take effect on any future scheduled payments.', ui: 'body1-primary', cls: 'body1-primary', id: 'FormPaymentReceipt_label_11' }] }] }] }, {xtype: 'label', name: 'EmailReceiptNotificationLabel', ui: 'body1-secondary', cls: 'body1-secondary', id: 'FormPaymentReceipt_EmailReceiptNotificationLabel' }, {xtype: 'label', name: 'EmailReceiptNotification', ui: 'body1-secondary', cls: 'body1-secondary', id: 'FormPaymentReceipt_EmailReceiptNotification' }, {xtype: 'label', name: 'ReceiptText', ui: 'body1-secondary', hidden: true, cls: 'body1-secondary', id: 'FormPaymentReceipt_ReceiptText' }, {xtype: 'hiddenfield', fieldLabel: 'ReceiptNavigation', label: 'ReceiptNavigation', labelSeparator: ' ', value: 'NavCreditCardReceipt', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'ReceiptNavigation is required', autoComplete: 'on', name: 'ReceiptNavigation', margin: '', id: 'FormPaymentReceipt_ReceiptNavigation', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'EntityID', label: 'EntityID', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'EntityID is required', autoComplete: 'on', name: 'EntityID', margin: '', id: 'FormPaymentReceipt_EntityID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'PkTransaction', label: 'PkTransaction', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'PkTransaction is required', autoComplete: 'on', name: 'PkTransaction', margin: '', id: 'FormPaymentReceipt_PkTransaction', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'Account ID', label: 'Account ID', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'Account ID is required', autoComplete: 'on', name: 'InstaMedAccountID', margin: '', id: 'FormPaymentReceipt_InstaMedAccountID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'Merchant ID', label: 'Merchant ID', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'Merchant ID is required', autoComplete: 'on', name: 'MerchantID', margin: '', id: 'FormPaymentReceipt_MerchantID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'Store ID', label: 'Store ID', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'Store ID is required', autoComplete: 'on', name: 'StoreID', margin: '', id: 'FormPaymentReceipt_StoreID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'Terminal ID', label: 'Terminal ID', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'Terminal ID is required', autoComplete: 'on', name: 'TerminalID', margin: '', id: 'FormPaymentReceipt_TerminalID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'Transaction Type', label: 'Transaction Type', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'Transaction Type is required', autoComplete: 'on', name: 'TransactionType', margin: '', id: 'FormPaymentReceipt_TransactionType', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'BusinessEntityType', label: 'BusinessEntityType', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'BusinessEntityType is required', autoComplete: 'on', name: 'BusinessEntityType', margin: '', id: 'FormPaymentReceipt_BusinessEntityType', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, { xtype: 'window', title: 'Have More Healthcare Bills?', titleAlign: 'center', itemId: 'HealthcareBillPaymentAd', flex: 1, defaultFocus: 'button', closable: true, modal: false, draggable: false, constrainHeader: true, constrainTo: 'mainBorderPanel', maskTapHandler: function() { this.hide()}, closeAction: 'hide', name: 'HealthcareBillPaymentAd', maxWidth: 300, flex: 1, id: 'FormPaymentReceipt_HealthcareBillPaymentAd', listeners: {show: function() { var listenerArgs = arguments; Ext.Array.each([function() { PerformAction({}, PayAnyDocController.updateHCBPInviteTracking,null); },function() { window.addEventListener('resize', setPositionOnResizeWithDelay); },function(cmp) { Ext.each(Ext.DomQuery.select('.x-panel-body', Ext.DomQuery.selectNode('.x-window[id=HealthcareBillPaymentAd]')), function(p) { Ext.get(p.id).scrollTo('top', 0); }); }], function(func) { func.apply(this, listenerArgs); }); }}, items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, name: 'MyFormPanel', ui: 'flat', itemId: 'MyFormPanel', flex: 1, cls: 'flat', scrollable: null, id: 'FormPaymentReceipt_MyFormPanel', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', flex: 1, hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_19' }, {xtype: 'label', html: 'With InstaMed, now you can pay all of your healthcare bills. Click below to find and pay your healthcare provider.', ui: 'subheading-secondary', flex: 1, cls: 'subheading-secondary', id: 'MyFormPanel_label_1' }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, flex: 1, cls: 'buttonContainer', scrollable: null, id: 'MyFormPanel_container_3', items: [ {xtype: 'spacer', flex: 1, id: 'MyFormPanel_spacer_2' }, {xtype: 'button', text: 'Learn More', name: 'HealthCareBillPaymentAdLearnMoreLinkButton', ui: 'small', flex: 1, margin: '', ariaRole: 'button', cls: 'small noprint', id: 'MyFormPanel_button_LearnMore', listeners: {tap: function() { window.open('https://help.instamed.com/patients/s/article/Getting-Started-With-InstaMed#')}} }, {xtype: 'button', text: 'Get Started', name: 'HealthCareBillPaymentAdSubmitLinkButton', ui: 'small', flex: 1, margin: '', ariaRole: 'button', cls: 'small noprint', id: 'MyFormPanel_button_GetStarted', listeners: {tap: function(cmp, e, eOpts) { if(InstaMed.isLoggedIn) {PerformAction({href:'../../Form/PaymentPortal/Dashboard?id=foxhallpodiatry&pageStep=NavFindProvider&Origin=PayeeSearch',hrefTarget:'_self'},PatientPortalLoginController.navigateTo); } else {PerformAction({href:'../../Form/PaymentPortal/Start?pageStep=NavFindProvider&Origin=PayeeSearch',hrefTarget:'_self'},PatientPortalLoginController.navigateTo); } }} }] }, {xtype: 'hiddenfield', fieldLabel: 'HCBPAdVisible', label: 'HCBPAdVisible', labelSeparator: ' ', value: true, required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'HCBPAdVisible is required', autoComplete: 'on', name: 'HCBPAdVisible', flex: 1, margin: '', id: 'MyFormPanel_HCBPAdVisible', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }] }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, cls: 'buttonContainer', scrollable: null, id: 'FormPaymentReceipt_container_18', items: [ {xtype: 'button', text: 'View Receipt', name: 'ViewReceipt', margin: '', hidden: true, ariaRole: 'button', cls: 'noprint', id: 'FormPaymentReceipt_button_ViewReceipt', listeners: {tap: function(cmp, newValue, oldValue, eOpts) {myForm = InstaMed.findParentForm(cmp);PerformAction(myForm.getValues(),PaymentHistoryController.viewPaymentReceipt,cmp);}} }, {xtype: 'button', text: 'View Receipt', name: 'ViewPaymentPlanReceipt', margin: '', hidden: true, ariaRole: 'button', cls: 'noprint', id: 'FormPaymentReceipt_button_ViewReceipt_1', listeners: {tap: function(cmp, newValue, oldValue, eOpts) {myForm = InstaMed.findParentForm(cmp);PerformAction(myForm.getValues(),QuickPayReviewAndConfirmController.viewReceipt,cmp);}} }, {xtype: 'spacer', id: 'FormPaymentReceipt_spacer' }, {xtype: 'button', text: 'Share Receipt', name: 'ShareReceipt', ui: 'secondary', margin: '', ariaRole: 'button', cls: 'shareReceipt secondary noprint', id: 'FormPaymentReceipt_button_ShareReceipt', listeners: {tap: function() { var form = InstaMed.getNavigationView(); form.push('ShareReceiptWindow'); }} }, {xtype: 'button', text: 'Log In', name: 'Login', ui: 'action', margin: '', hidden: true, ariaRole: 'button', cls: 'action noprint', id: 'FormPaymentReceipt_button_LogIn', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),QuickPayPaymentSummaryController.redirectToLogin,cmp,undefined,undefined,undefined,undefined,undefined); }} }, {xtype: 'button', text: 'Sign Up for Account', name: 'btnSignUp', ui: 'action', margin: '', hidden: true, ariaRole: 'button', cls: 'action noprint', id: 'FormPaymentReceipt_button_SignUpforAccount', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),QuickPayPaymentSummaryController.redirectToSignUp,cmp,undefined,undefined,undefined,undefined,undefined); }} }, {xtype: 'button', text: 'Explore My Account', name: 'ExploreMyAccount', ui: 'action', margin: '', hidden: true, ariaRole: 'button', cls: 'action noprint', id: 'FormPaymentReceipt_button_ExploreMyAccount', listeners: {tap: function(cmp, newValue, oldValue, eOpts) { myForm = InstaMed.findParentForm(cmp); PerformAction(myForm.getValues(),QuickPayPaymentSummaryController.redirectToPatientProfile,cmp,undefined,undefined,undefined,undefined,undefined); }} }] }] }] }] }] }] }, {xtype: 'spacer', flex: 1, id: 'spacer_48' }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, cls: 'x-panel-footer im-powered-by', scrollable: null, id: 'container_54', items: [ {xtype: 'spacer', id: 'spacer_49' }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn ', scrollable: null, id: 'NavReceiptPreview_container_7', items: [ {xtype: 'image', name: 'poweredbylogo', cls: 'hidden hiddenxs hiddensm', id: 'NavReceiptPreview_poweredbylogo' }, {xtype: 'container', cls: 'copyrightContainer hiddenxs hiddensm', scrollable: null, id: 'NavReceiptPreview_container_8', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavReceiptPreview_spacer_4' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavReceiptPreview_button_copyrightFooter' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavReceiptPreview_spacer_5' }] }, {xtype: 'spacer', cls: 'hiddenxs hiddensm', id: 'NavReceiptPreview_spacer_6' }, {xtype: 'container', cls: 'linkButtonContainer hiddenxs hiddensm', scrollable: null, id: 'NavReceiptPreview_container_9', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_Security', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_Privacy', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_Terms', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_Help', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }, {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenxs hiddensm', id: 'menuitem_en_32'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenxs hiddensm', id: 'menuitem_es_32'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenxs hiddensm', id: 'menuitem_fr_32'},], name: 'ForeignLanguages', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_ForeignLanguages' }] }, {xtype: 'container', cls: 'hiddenmd hiddenlg', scrollable: null, id: 'NavReceiptPreview_container_10', items: [ {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavReceiptPreview_container_11', items: [ {xtype: 'spacer', id: 'NavReceiptPreview_spacer_7' }, {xtype: 'image', name: 'poweredbylogo', cls: 'hidden', id: 'NavReceiptPreview_poweredbylogo_1' }, {xtype: 'spacer', id: 'NavReceiptPreview_spacer_8' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavReceiptPreview_container_12', items: [ {xtype: 'spacer', id: 'NavReceiptPreview_spacer_9' }, {xtype: 'container', cls: 'copyrightContainer', scrollable: null, id: 'NavReceiptPreview_container_13', items: [ {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavReceiptPreview_spacer_10' }, {xtype: 'button', text: '© 2022 InstaMed. All Rights Reserved.', name: 'copyrightFooter', ui: 'dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style dark-grey noprint', id: 'NavReceiptPreview_button_copyrightFooter_1' }, {xtype: 'spacer', cls: 'hiddenmd hiddenlg', id: 'NavReceiptPreview_spacer_11' }] }, {xtype: 'spacer', id: 'NavReceiptPreview_spacer_12' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavReceiptPreview_container_14', items: [ {xtype: 'spacer', id: 'NavReceiptPreview_spacer_13' }, {xtype: 'container', cls: 'linkButtonContainer ', scrollable: null, id: 'NavReceiptPreview_container_15', items: [ {xtype: 'button', text: 'Security', iconCls: 'x-ma ma-lock-outline', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_Security_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/security/','open-window');}} }, {xtype: 'button', text: 'Privacy', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_Privacy_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/privacy-statement/','open-window');}} }, {xtype: 'button', text: 'Terms', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_Terms_1', listeners: {tap: function() { InstaMed.popupNewWindow('https://www.instamed.com/terms-of-use/','open-window');}} }, {xtype: 'button', text: 'Help', ui: 'grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_Help_1', listeners: {tap: function() { InstaMed.popupNewWindow('../../Form/PaymentPortal/ContactUs?id=foxhallpodiatry','open-window');}} }] }, {xtype: 'spacer', id: 'NavReceiptPreview_spacer_14' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'center'}, cls: 'x-center-helper', scrollable: null, id: 'NavReceiptPreview_container_16', items: [ {xtype: 'spacer', id: 'NavReceiptPreview_spacer_15' }, {xtype: 'container', scrollable: null, id: 'NavReceiptPreview_container_17', items: [ {xtype: 'button', text: 'English', align: 'right',menu:[{xtype: 'menuitem', text: 'English', handler: function(cmp) { PerformAction({Language:'en'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'en', cls: 'hiddenmd hiddenlg', id: 'menuitem_en_33'},{xtype: 'menuitem', text: 'Español', handler: function(cmp) { PerformAction({Language:'es'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'es', cls: 'hiddenmd hiddenlg', id: 'menuitem_es_33'},{xtype: 'menuitem', text: 'Français', handler: function(cmp) { PerformAction({Language:'fr'}, PatientPortalLoginController.changeLanguage,cmp); }, name: 'fr', cls: 'hiddenmd hiddenlg', id: 'menuitem_fr_33'},], name: 'ForeignLanguages', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style grey noprint', id: 'NavReceiptPreview_button_ForeignLanguages_1' }] }, {xtype: 'spacer', id: 'NavReceiptPreview_spacer_16' }] }] }] }, {xtype: 'spacer', id: 'spacer_50' }] }] }, { xtype: 'window', title: 'Share Receipt', titleAlign: 'center', itemId: 'ShareReceiptWindow', flex: 1, defaultFocus: 'textfield', closable: true, modal: true, draggable: false, constrainHeader: true, constrainTo: 'mainBorderPanel', closeAction: 'hide', name: 'ShareReceiptWindow', ui: 'medium', flex: 1, cls: 'medium', id: 'ShareReceiptWindow', listeners: {show: function(cmp) { Ext.each(Ext.DomQuery.select('.x-panel-body', Ext.DomQuery.selectNode('.x-window[id=ShareReceiptWindow]')), function(p) { Ext.get(p.id).scrollTo('top', 0); }); }}, items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { submit: QuickPayReviewAndConfirmController.emailReceipt }, defaultSubmitButton: 'Submit', allowReset: false, name: 'MyFormPanel', ui: 'flat', itemId: 'MyFormPanel', flex: 1, cls: 'flat', scrollable: null, id: 'MyFormPanel_2', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', flex: 1, hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_22' }, {xtype: 'container', flex: 1, scrollable: null, id: 'MyFormPanel_container_4', items: [ {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 200, maxLength: 200, enforceMaxLength: true, minLength: 0, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Email Receipt To:', label: 'Email Receipt To:', component: {"type":"email","pattern":null}, inputType: 'email', labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Email Receipt To: is required', autoComplete: 'on', name: 'Email', flex: 5, margin: '', id: 'MyFormPanel_Email', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'TransactionAccountID', label: 'TransactionAccountID', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'TransactionAccountID is required', autoComplete: 'on', name: 'TransactionAccountID', flex: 1, margin: '', id: 'MyFormPanel_TransactionAccountID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'TransactionGroupID', label: 'TransactionGroupID', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'TransactionGroupID is required', autoComplete: 'on', name: 'TransactionGroupID', flex: 1, margin: '', id: 'MyFormPanel_TransactionGroupID', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'PkTransaction', label: 'PkTransaction', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'PkTransaction is required', autoComplete: 'on', name: 'PkTransaction', flex: 1, margin: '', id: 'MyFormPanel_PkTransaction', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'Transaction Type', label: 'Transaction Type', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'Transaction Type is required', autoComplete: 'on', name: 'TransactionType', flex: 1, margin: '', id: 'MyFormPanel_TransactionType', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'TransactionAction', label: 'TransactionAction', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'TransactionAction is required', autoComplete: 'on', name: 'TransactionAction', flex: 1, margin: '', id: 'MyFormPanel_TransactionAction', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }, {xtype: 'hiddenfield', fieldLabel: 'IsPaymentPlanFlow', label: 'IsPaymentPlanFlow', labelSeparator: ' ', required: false, labelWrap: true, errorTarget: 'under', clearable: false, requiredMessage: 'IsPaymentPlanFlow is required', autoComplete: 'on', name: 'IsPaymentPlanFlow', flex: 1, margin: '', id: 'MyFormPanel_IsPaymentPlanFlow', listeners: {blur: function(cmp){if(cmp.validate){cmp.validate();}}} }] }, {xtype: 'container', flex: 1, scrollable: null, id: 'MyFormPanel_container_5', items: [ {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, flex: 1, cls: 'buttonContainer', scrollable: null, id: 'MyFormPanel_container_6', items: [ {xtype: 'button', text: 'Cancel', flex: 1, margin: '', ariaRole: 'button', cls: 'noprint', id: 'MyFormPanel_button_Cancel', listeners: {tap: function(cmp, e, options) { InstaMed.getNavigationView().back(); }} }, {xtype: 'spacer', flex: 1, id: 'MyFormPanel_spacer_3' }, {xtype: 'button', text: 'Send', name: 'Submit', ui: 'action', flex: 1, margin: '', ariaRole: 'button', cls: 'action noprint', id: 'MyFormPanel_button_Send', listeners: {tap: function(cmp, e, options) { var cmpForm = InstaMed.findParentForm(cmp); InstaMed.submitForm(cmpForm,function(cmp, e, options) { InstaMed.getNavigationView().back(); }); }} }] }] }] }] }, {xtype: 'container', name: 'NavAPCTerms', layout: {type: 'vbox', pack: 'start'}, scrollable: 'true', id: 'NavAPCTerms', items: [ {xtype: 'container', docked: 'top', scrollable: null, id: 'NavAPCTerms_container', items: [ {xtype: 'instamedNavigationBar', name: 'headerBar', layout: {type: 'hbox'}, hidden: false, cls: 'im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavAPCTerms_headerBar', items: [ {xtype: 'spacer', id: 'NavAPCTerms_spacer', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'titlebar', title: '<a href=\\"../../Form/PaymentPortal/Start\\"> <img width=\\"101\\" height=\\"32\\" src=\\"../../Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry\\">', maxWidth: 1272, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn im-ignore-custom-colors im-ignore-background', scrollable: null, id: 'NavAPCTerms_titlebar', plugins: 'responsive', responsiveConfig: {'width >= 1272':{title :'',},'width < 1272':{title : ' ',},}, items: [ {xtype: 'button', accessibleText: 'Back', iconCls: 'x-ma ma-arrow-back', align: 'left', name: 'TitleBarNavigationViewBack', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-icon-link-style white hiddenlg noprint', id: 'NavAPCTerms_TitleBarNavigationViewBack', plugins: 'responsive', responsiveConfig: {'width > 1272':{iconCls :'',},'width <= 1272':{iconCls : 'x-ma ma-arrow-back',},}, listeners: {tap: function(cmp, e, options) { InstaMed.getNavigationView().back(); }} }, {xtype: 'image', width: 127, height: 40, src: 'https://instamedprd.cachefly.net/V_2022_August/Content/Images/General/instamed-tagged-white.png?id=foxhallpodiatry', align: 'left', cls: 'x-clickable x-image-size-contain', id: 'NavAPCTerms_image', plugins: 'responsive', responsiveConfig: {'width >= 1272':{hidden : false,},'width < 1272':{hidden :true,},}, listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Start'; }} }, {xtype: 'button', name: 'HeaderTitlebarButton', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style im-center-header-button white noprint', id: 'NavAPCTerms_HeaderTitlebarButton' }, {xtype: 'button', text: 'Pay Any Healthcare Bill', align: 'right', name: 'PayAnyHealthcareBillButton', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style x-border hiddenxs hiddensm white noprint', id: 'NavAPCTerms_button_PayAnyHealthcareBill', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?id=foxhallpodiatry&pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', text: 'Pay Bills', iconCls: 'x-ma ma-search', iconAlign: 'top', align: 'right', name: 'PayAnyHealthcareBillIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-ontop-link-style white hiddenmd hiddenlg noprint', id: 'NavAPCTerms_button_PayBills', listeners: {tap: function() { if(InstaMed.isLoggedIn) { window.location.href ='../../Form/PaymentPortal/Dashboard?pageStep=NavFindProvider'; } else { window.location.href ='../../Form/PaymentPortal/Start?pageStep=NavFindProvider'; }}} }, {xtype: 'button', accessibleText: 'Log In or Sign Up', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Log In', handler: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }, id: 'menuitem_LogIn_20'},{xtype: 'menuitem', text: 'Sign Up', handler: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }, id: 'menuitem_SignUp_20'},], name: 'LoginOrSignUpProfileIcon', margin: '', ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavAPCTerms_button_LoginOrSignUpProfileIcon', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: true,},'!InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=LoginOrSignUpProfileIcon]')[0].getMenu().hide(); }} }, {xtype: 'button', text: '', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_40'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_40'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_40'},], name: 'Profile', ui: 'white', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-link-style white noprint', id: 'NavAPCTerms_button_Profile', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: false,},'InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=Profile]')[0].getMenu().hide(); }} }, {xtype: 'container', align: 'right', name: 'LoginOrSignUpContainer', layout: {type: 'hbox'}, scrollable: null, id: 'NavAPCTerms_LoginOrSignUpContainer', plugins: 'responsive', responsiveConfig: {'!InstaMed.isLoggedIn & width > 960':{hidden: false,},'!InstaMed.isLoggedIn && width <= 960':{hidden: true,},}, items: [ {xtype: 'button', text: 'Log In', align: 'right', name: 'LoginForDualLogin', ui: 'white', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavAPCTerms_button_LoginForDualLogin', listeners: {tap: function() { PerformAction({}, PatientPortalLoginController.redirectToLogin,null); }} }, {xtype: 'label', html: 'or', align: 'right', name: 'Or', ui: 'body1-white', cls: 'hiddenxs hiddensm body1-white', id: 'NavAPCTerms_Or' }, {xtype: 'button', text: 'Sign Up', align: 'right', name: 'SignUpForDualLogin', ui: 'white', margin: '', ariaRole: 'button', cls: 'x-button-link-style hiddenxs hiddensm white noprint', id: 'NavAPCTerms_button_SignUpForDualLogin', listeners: {tap: function() { PerformAction({}, SignUpController.redirectToSignUp,null); }} }] }, {xtype: 'button', accessibleText: 'Profile', iconCls: 'x-ma ma-account-circle', align: 'right',menu:[{xtype: 'menuitem', text: 'Dashboard', handler: function(){ window.location.href='../../Form/PaymentPortal/Dashboard'; }, id: 'menuitem_Dashboard_41'},{xtype: 'menuitem', text: 'Help', handler: function() { window.open('https://help.instamed.com/patients/s/?dc_label=Patients')}, id: 'menuitem_Help_41'},{xtype: 'menuitem', text: 'Log Out', handler: function(){ window.location.href='../../Form/PaymentPortal/Logout?id=foxhallpodiatry'; }, id: 'menuitem_LogOut_41'},], name: 'ProfileIcon', margin: '', hidden: true, ariaRole: 'button', cls: 'x-button-icon-link-style white noprint', id: 'NavAPCTerms_button_ProfileIcon', plugins: 'responsive', responsiveConfig: {'InstaMed.isLoggedIn & width > 960':{hidden: true,},'InstaMed.isLoggedIn && width <= 960':{hidden: false,},}, listeners: {hiddenchange: function() { Ext.ComponentQuery.query('[name=ProfileIcon]')[0].getMenu().hide(); }} }] }, {xtype: 'spacer', id: 'NavAPCTerms_spacer_1', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }] }, {xtype: 'container', layout: {type: 'hbox'}, cls: 'x-subheader-container', scrollable: null, id: 'NavAPCTerms_container_1', items: [ {xtype: 'spacer', id: 'NavAPCTerms_spacer_2', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }, {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'largeTwelveColumn mediumTwelveColumn smallTwelveColumn xsmallTwelveColumn x-subheader-panel ', scrollable: null, id: 'NavAPCTerms_container_2', items: [ {xtype: 'button', text: 'FP', ui: 'grey', margin: '', hidden: false, ariaRole: 'button', cls: 'x-button-link-style x-button-provider-logo grey noprint', id: 'NavAPCTerms_button_FP', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'vbox', pack: 'center', align: 'left'}, cls: 'im-provider-header-buttons', scrollable: null, id: 'NavAPCTerms_container_3', items: [ {xtype: 'button', text: 'Foxhall Podiatry Associates, PC', name: 'SubheaderProviderName', ui: 'inline-dark-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style im-bold-button inline-dark-grey noprint', id: 'NavAPCTerms_button_SubheaderProviderName', listeners: {tap: function(){ window.location.href='../../Form/PaymentPortal/Default?id=foxhallpodiatry'; }} }, {xtype: 'container', layout: {type: 'hbox'}, scrollable: null, id: 'NavAPCTerms_container_4', items: [ {xtype: 'container', html: '', hidden: true, cls: 'im-address-verification-icon', scrollable: null, id: 'NavAPCTerms_container_5' }, {xtype: 'button', text: '3301 New Mexico Avenue, NW Suite 232, Washington, DC 20016', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style inline-grey noprint', id: 'NavAPCTerms_button_3301NewMexicoAvenueNWSuite232Washin' }] }, {xtype: 'container', layout: {type: 'hbox'}, hidden: false, scrollable: null, id: 'NavAPCTerms_container_6', items: [ {xtype: 'button', text: '(202) 966-4811', ui: 'inline-grey', margin: '', ariaRole: 'button', cls: 'x-button-link-style subheaderPhoneNumber inline-grey noprint', id: 'NavAPCTerms_button_2029664811' }] }] }] }, {xtype: 'spacer', id: 'NavAPCTerms_spacer_3', plugins: 'responsive', responsiveConfig: {'width > 1272':{flex : 1,},'width <= 1272':{flex :0,},} }] }, { xtype: 'panel', dock: 'top', frame: false, scrollable: 'true', id: 'panel_20', items: [ {xtype: 'container', maxWidth: 1272, layout: {type: 'hbox'}, cls: 'mainContent MainContentWithHeaerAndSubheader ', scrollable: null, id: 'container_64', items: [ {xtype: 'container', flex: 1, scrollable: null, id: 'container_65', items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, name: 'MyFormPanel', itemId: 'MyFormPanel', cls: 'col-large-offSet-3 col-medium-offSet-3 col-small-offSet-1 smallTenColumn xsmallTwelveColumn mediumSixColumn largeSixColumn ', scrollable: null, id: 'MyFormPanel_3', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_24' }, {xtype: 'instamedHeading1', text: 'Automatic Payment Authorization', id: 'MyFormPanel_instamedHeading1_1' }, {xtype: 'container', html: ' Consent and Authorized Amount. By clicking “Confirm” below to enroll in Automatic Payments, I authorize and request that my Service Provider charge the debit or credit card I have designated or electronically debit my bank account to pay my balance owed, up to $1,000, for insurance premiums or in connection with healthcare services rendered. Amounts owed in excess of $1,000 in a given month will be debited by Service Provider once per month each following month up to $1,000 until my balance is paid. Service Provider will debit my payments in the amounts and on the dates disclosed to me on my billing statements provided to me electronically. “Service Provider” means Foxhall Podiatry Associates, PC and all its affiliated and related organizations.I agree that it is my responsibility to maintain sufficient funds in my account until each transaction I authorize processes. I acknowledge that I am also responsible for all fees charged by my financial institution associated with the transactions authorized. If a payment is rejected due to insufficient funds, I agree that Foxhall Podiatry Associates, PC may attempt to process the transaction again and may debit a returned item fee. I acknowledge that I will be liable for any fees, including insufficient funds or returned entry fees. I also authorize Foxhall Podiatry Associates, PC to electronically debit or credit my account to correct any erroneous transfers.IMPORTANT: If paying for healthcare services rendered, the following consent applies.This authorization applies separately to each of Service Provider\'s patient accounts billed to me and the balances that I owe under each of those patient accounts. A patient account is a financial obligation as a result of a visit to Foxhall Podiatry Associates, PC. I understand that a Service Provider may create multiple patient accounts for me as a result of a single visit to Service Provider, and that multiple patient accounts may be listed on a single statement I receive in the mail. For example, a single radiology service visit may result in one statement mailed to me with two patient accounts against each patient account under this authorization: one charge for the facility usage and another charge for a radiologist to interpret the test. Duration of Authorization; Termination and Modification.This authorization will remain in effect until I terminate it. I understand that I have the right to terminate or modify this authorization, including updating my payment method, by logging into www.pay.instamed.com and modifying or discontinuing automatic payments or by notifying my Service Provider in writing to 3301 New Mexico Avenue, NW Suite 232, Washington, DC 20016 or calling (202) 966-4811. I understand that the termination of this authorization in no way relieves me of the obligation to fulfill my obligations to my Service Provider. My request to terminate or update this authorization will be effective only after my Service Provider has had a reasonable opportunity to act upon my request, at least three (3) business days. Transactions and Accounts.I authorize my debit / credit card issuer and / or financial institution (bank) to honor transactions processed by this authorization. I certify that I am an owner of or authorized signer for the debit / credit card or the designated bank account with the Account Number and Routing Number listed under the ”Payment Method” on the “Review & Confirm” page. I acknowledge that a transaction involving an ACH debit from my bank account is subject to the Rules and Operating Guidelines of National Automated Clearing House Association and charge to my card is subject to the card brand rules and any agreement between me and my card issuer. Acknowledgement.I understand that I should read this authorization carefully and keep a copy for my records. To receive a copy of this authorization for no charge I may contact my Service Provider at the address or phone number provided in Section 2 above. Communications to be Provided Electronically.By enrolling in Automatic Payments, you also consent that, now and in the future, any information, notices, and disclosures in connection with this authorization may be provided to you electronically in lieu of providing such communications being provided on paper. Updating Contact Information. I can change my contact information by configuring my account settings on this website or by writing to or calling my Service Provider using the information provided in Section 2 above. Online and Mobile E-Sign Disclosure and Consent. Definitions for purposes of Section 7. \t\t“Communication” is defined in Section 7(b) below. \t\t\t \t\t\t“Electronic Delivery” is the act of delivering Communications using electrical, digital, magnetic, wireless, optical, electromagnetic, or similar electronic means as set forth in Section 7(d) below, including through our websites or mobile applications. \t\t\t \t“We,” “us,” and “our,” refer to the entity that provides you one or more Services and such entity’s affiliates and subsidiaries or our agents, assignees or service providers. Consent and Scope of Communications to be Provided Electronically. \t\tWe are required by law, regulation or agreement to give you certain information “in writing”. With your consent, we can provide this information to you by Electronic Delivery instead. We also need your general consent to use electronic records and signatures in our relationship with you.You agree that for all Communications for Services we may use Electronic Delivery and, at our discretion, terminate paper delivery of Communications to you unless and until you withdraw your consent to this Section 7 as described in Section 7(f) below. This Section 7 applies to all Communications relating to such Services. “Communications” include, but are not limited to, the following: \t\t\tAll legal, regulatory or other disclosures associated with a Service; All documentation or communications relevant to a Service, including agreements, amendments, policies and procedures (including but not limited to our privacy policy), terms and conditions, authorizations, confirmations of transactions, updates, notices, responses to claims, and transaction history; \t\t\t Marketing materials; and \t\t\t Any other document or other information required to be provided “in writing” or that we otherwise provide to you, or that you sign or submit or agree to at our request, in connection with Services or your relationship with us. \t\t\t Delivery. Except as otherwise provided in this Section 7, physical delivery of Communications is not available for these Services. We reserve the right, but assume no obligation, to provide paper copies of any Communication that you have authorized us to provide via Electronic Delivery.To withdraw your consent to receive Communications by Electronic Delivery, you must follow the instructions set forth in the section titled “How to Withdraw Consent” in Section 7(f) below. Sometimes you are required to provide us with a written notice by law or under our agreement with you. Those notices must be provided to us on paper unless we tell you how to deliver the notice to us electronically.Method of Electronic Delivery. All Communications (including alerts that Communications have been provided or posted) that we provide to you electronically will be provided by one or more of the following methods: electronic messaging (such as e-mail, or SMS text or push notification to your mobile device); by access to a web site, including our mobile websites or websites of third party service providers who we engage to deliver Communications through Electronic Delivery, that we will designate in a notice we send to you via electronic messaging at the time the information is available or that we will generally designate in advance for such purpose; via our mobile applications; or by requesting you download a Hyper Text Markup Language (“HTML”) file or Portable Document Format (“PDF”) or other specified electronic file containing the Communication. Communications delivered by e-mail will be sent to your e-mail address reflected in our records. You represent that any e-mail address you provide to us for Electronic Delivery purposes belongs to you or to a person who has authority for Services. You should print, download or otherwise retain a copy of this Section 7 and all other Communications provided by Electronic Delivery. Hardware and Software Requirements. In order to access, view, print and retain electronic Communications, you must have: Access to a device (e.g., computer, smartphone, mobile device, tablet, etc.) suitable for connecting to the internet, or downloading our mobile apps with the Current Version (as defined below) of (i) an operating system, such as Windows, Mac OS, iOS or Android, and (ii) a web browser, such as Chrome, Safari or Firefox, that we support; A connection to the internet; Local electronic storage capacity to retain Communications and/or a printer to print them; A valid e-mail account and software to access it; li>Software that enables you to view and display files in HTML and PDF format. By “Current Version,” we mean a version of the software that is currently being supported by its publisher. From time to time, we may offer services or features that require that your internet browser be configured in a particular way, such as permitting the use of cookies. If we detect that your Internet browser is not properly configured, we may provide you with a notice and advice on how to update your configuration. We reserve the right to discontinue support of a Current Version of software or an operating system if, in our sole opinion, it suffers from a security flaw or other flaw that makes it unsuitable for use. If our hardware or software requirements change, and that change would create a material risk that you would not be able to access or retain electronic Communications, we will give you notice of the revised hardware or software requirements. Continuing to use the Services after receiving notice of the change is reaffirmation of your consent with respect to other Communications. How to Withdraw Consent. We will not impose any fee to process the withdrawal of your consent to receive Communications by Electronic Delivery. However, if you withdraw consent, your access to and use of the Services or certain features of the Services will be terminated. Any withdrawal of your consent to receive Communications by Electronic Delivery will be effective only after we have a reasonable period of time to process your withdrawal. At our option, we may treat the provision of an invalid e-mail address, or the subsequent malfunction of a previously valid e-mail address, as a withdrawal of your consent to receive Communications by Electronic Delivery. You may withdraw your consent to receive Electronic Delivery of Communications by calling us at (866) 467-8263. Requesting Paper Copies. For Communications scheduled for Electronic Delivery, you should not expect to receive a paper copy of any Communication unless you request it. You can obtain a paper copy of an electronic Communication by printing it yourself or by requesting that we mail you a paper copy, provided that such request is made within a reasonable time after we first provided the Communication to you by Electronic Delivery. We may charge you a reasonable service charge, with prior notice of any such charge, for the delivery of paper copies of any Communication provided to you electronically pursuant to this Section 7. To request paper copies of electronic Communications, call us at (866) 467-8263. Federal Law. You acknowledge and agree that your consent to this Section 7 is provided in connection with a transaction affecting interstate commerce, that it is subject to the federal Electronic Signatures in Global and National Commerce Act (the “E-SIGN Act”), and that you and we both intend that the E-SIGN Act apply to the fullest extent permitted by law. Termination/Changes. We reserve the right, in our sole discretion, to discontinue providing you with electronic Communications, or to terminate or change the terms and conditions on which we provide electronic Communications. We will provide you with notice of any such termination or change as required by law. Acceptance and Consent. By consenting to this Section 7, you agree to the following statements: I have read, understand and agree to be bound by the terms and conditions contained in this Section 7, and consent to receive Communications and execute documents via Electronic Delivery according to the process described herein; I am able to download and review files in HTML or PDF format, and I have internet access and can send and receive emails with links to websites;Certain Communications may be delivered to me in paper form and in the future some or all of these Communications may be made available for me to view electronically in accordance with this Section 7;My consent to receive Communications electronically does not automatically expire and is not limited as to duration;I may incur costs, including but not limited to online time and other charges from my internet service provider or telephone carrier in accessing and/or viewing Communications;I may terminate or suspend Electronic Delivery at any time at my discretion and I understand that this will terminate my access to the Site; andWe will not be liable for any loss, liability, cost, expense, or claim for acting upon this authorization or arising from my use of the product or services provided pursuant to this Section 7. 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}); }}, items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, name: 'MyFormPanel', ui: 'flat', itemId: 'MyFormPanel', flex: 1, cls: 'flat', scrollable: null, id: 'MyFormPanel_4', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', flex: 1, hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_25' }, {xtype: 'container', flex: 1, scrollable: null, id: 'MyFormPanel_container_8', items: [ {xtype: 'dataviewlite', tpl: '\r\n \r\n \r\n \r\n \r\n {Description}\r\n \r\n \r\n {Amount}\r\n \r\n \r\n \r\n {Description}\r\n \r\n \r\n {Amount}\r\n \r\n \r\n \r\n \r\n ', itemSelector: '.im-dataview-tile-payment-plan', deferInitialRefresh: false,store: Ext.data.StoreManager.lookup('PaymentPlanPaymentsBreakdownStore'), name: 'PaymentPlanPaymentsBreakdownDataView', flex: 1, id: 'MyFormPanel_PaymentPlanPaymentsBreakdownDataView' }] }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, flex: 1, cls: 'buttonContainer', scrollable: null, id: 'MyFormPanel_container_9', items: [ {xtype: 'spacer', flex: 1, id: 'MyFormPanel_spacer_5' }, {xtype: 'button', text: 'Close', ui: 'secondary', flex: 1, margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'MyFormPanel_button_Close', listeners: {tap: function(cmp, e, options) { InstaMed.getNavigationView().back(); }} }] }] }] }, { xtype: 'window', title: 'Paperless Statements', titleAlign: 'center', itemId: 'EStatementEnrollmentInfo', flex: 1, defaultFocus: 'button', closable: true, modal: true, draggable: false, constrainHeader: true, constrainTo: 'mainBorderPanel', closeAction: 'hide', name: 'EStatementEnrollmentInfo', ui: 'medium', flex: 1, cls: 'medium', id: 'EStatementEnrollmentInfo', listeners: {painted: function(cmp, eOpts){ var myHeight = cmp.getSize().height; var windowHeight = Ext.getBody().getViewSize().height; var yPos = Math.max((windowHeight-myHeight)/2, 0); cmp.setY(yPos); },show: function(cmp) { Ext.each(Ext.DomQuery.select('.x-panel-body', Ext.DomQuery.selectNode('.x-window[id=EStatementEnrollmentInfo]')), function(p) { Ext.get(p.id).scrollTo('top', 0); }); }}, items: [ {xtype: 'label', html: 'View current and past statements from your phone, tablet, or computer anytime and save paper too. You can choose to receive paper statements again after enrolling in paperless statements by visiting your preferences.', ui: 'body1-secondary', flex: 1, cls: 'body1-secondary', id: 'label_1' }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, flex: 1, cls: 'buttonContainer im-bottom-label', scrollable: null, id: 'container_67', items: [ {xtype: 'spacer', flex: 1, id: 'spacer_63' }, {xtype: 'button', text: 'Close', name: 'btnClose', ui: 'action', flex: 1, margin: '', ariaRole: 'button', cls: 'action noprint', id: 'button_Close', listeners: {tap: function(cmp, e, options) { InstaMed.getNavigationView().back(); }} }] }] }, { xtype: 'window', title: 'Paperless Statements', titleAlign: 'center', itemId: 'EStatementEnrollmentInfo', flex: 1, defaultFocus: 'button', closable: true, modal: true, draggable: false, constrainHeader: true, constrainTo: 'mainBorderPanel', closeAction: 'hide', name: 'EStatementEnrollmentInfo', ui: 'medium', flex: 1, cls: 'medium', id: 'EStatementEnrollmentInfo_1', listeners: {painted: function(cmp, eOpts){ var myHeight = cmp.getSize().height; var windowHeight = Ext.getBody().getViewSize().height; var yPos = Math.max((windowHeight-myHeight)/2, 0); cmp.setY(yPos); },show: function(cmp) { Ext.each(Ext.DomQuery.select('.x-panel-body', Ext.DomQuery.selectNode('.x-window[id=EStatementEnrollmentInfo]')), function(p) { Ext.get(p.id).scrollTo('top', 0); }); }}, items: [ {xtype: 'label', html: 'View current and past statements from your phone, tablet, or computer anytime and save paper too. You can choose to receive paper statements again after enrolling in paperless statements by visiting your preferences.', ui: 'body1-secondary', flex: 1, cls: 'body1-secondary', id: 'label_2' }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, flex: 1, cls: 'buttonContainer im-bottom-label', scrollable: null, id: 'container_68', items: [ {xtype: 'spacer', flex: 1, id: 'spacer_64' }, {xtype: 'button', text: 'Close', name: 'btnClose', ui: 'action', flex: 1, margin: '', ariaRole: 'button', cls: 'action noprint', id: 'button_Close_1', listeners: {tap: function(cmp, e, options) { InstaMed.getNavigationView().back(); }} }] }] }, { xtype: 'window', title: 'Mobile Phone Number', titleAlign: 'center', itemId: 'EditMobilePhoneWindow', flex: 1, defaultFocus: 'textfield', closable: true, modal: true, draggable: false, constrainHeader: true, constrainTo: 'mainBorderPanel', closeAction: 'hide', name: 'EditMobilePhoneWindow', ui: 'medium', flex: 1, cls: 'medium', id: 'EditMobilePhoneWindow', listeners: {painted: function(cmp, eOpts){ var myHeight = cmp.getSize().height; var windowHeight = Ext.getBody().getViewSize().height; var yPos = Math.max((windowHeight-myHeight)/2, 0); cmp.setY(yPos); },show: function(cmp) { Ext.each(Ext.DomQuery.select('.x-panel-body', Ext.DomQuery.selectNode('.x-window[id=EditMobilePhoneWindow]')), function(p) { Ext.get(p.id).scrollTo('top', 0); }); }}, items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { }, name: 'EditMobilePhoneNumber', ui: 'flat', itemId: 'EditMobilePhoneNumber', flex: 1, cls: 'flat', scrollable: null, id: 'EditMobilePhoneNumber', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', flex: 1, hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_27' }, {xtype: 'textfield', allowBlank: false, allowOnlyWhitespace: false, maxLength: 14, maxLength: 14, enforceMaxLength: true, minLength: 10, selectOnFocus: true, autoCorrect: false, fieldLabel: 'Mobile Phone Number', label: 'Mobile Phone Number', component: {"type":"tel","pattern":null}, inputType: 'tel', labelSeparator: ' ', required: true, labelWrap: true, labelAlign: 'placeholder', errorTarget: 'under', clearable: false, requiredMessage: 'Mobile Phone Number is required', autoComplete: 'on', name: 'MobilePhoneNumber2', flex: 1, margin: '', id: 'EditMobilePhoneNumber_MobilePhoneNumber2', listeners: {action: submitOnEnter,blur: function(cmp){if(cmp.validate){cmp.validate();}},change: function(field, event, opts ){ var s = new String(field.getValue()); if(s != null & s != '') { s = s.replace(/[-,()\s]/g,'');var newValue='(';newValue+=s.substring(0,3);if(s.length>3){newValue+=') ';}newValue+=s.substring(3,6);if(s.length>6){newValue+='-';}newValue+=s.substring(6,10); if(isNaN(parseInt(newValue.substring(1,3)))){ newValue = ''; } field.setValue(newValue); if(InstaMed.isResponsive){ field.setInputValue(newValue); } } }} }, {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, flex: 1, cls: 'buttonContainer', scrollable: null, id: 'EditMobilePhoneNumber_container', items: [ {xtype: 'spacer', flex: 1, id: 'EditMobilePhoneNumber_spacer' }, {xtype: 'button', text: 'Cancel', ui: 'secondary', flex: 1, margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'EditMobilePhoneNumber_button_Cancel', listeners: {tap: function(){ windowCmp = Ext.ComponentQuery.query('[name=EditMobilePhoneWindow]')[0].hide() }} }, {xtype: 'button', text: 'Verify', name: 'Submit', ui: 'secondary', flex: 1, margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'EditMobilePhoneNumber_button_Verify', listeners: {tap: function() { PerformAction({MobilePhoneNumber2:InstaMed.getValue('MobilePhoneNumber2'),EnableTwoStepVerification:Ext.ComponentQuery.query("[name='EnableTwoStepVerification']")[0].isChecked()}, TextMessageEnrollmentController.updateMobilePhoneNumberFromPopUp,null); }} }] }] }] }, { xtype: 'window', title: 'Inactivity Alert', titleAlign: 'center', itemId: 'NavPageIdleTimeoutForm', flex: 1, defaultFocus: 'button', closable: true, modal: true, draggable: false, constrainHeader: true, constrainTo: 'mainBorderPanel', closeAction: 'hide', name: 'NavPageIdleTimeoutForm', maxWidth: 400, flex: 1, id: 'NavPageIdleTimeoutForm', listeners: {beforeshow: function(){ InstaMed.query("Logout") & InstaMed.query("Logout").setVisible(InstaMed.isLoggedIn); if(!InstaMed.isSSO){ InstaMed.query("IdleTimerNotification") & InstaMed.query("IdleTimerNotification").setHtml && InstaMed.query("IdleTimerNotification").setHtml(InstaMed.isLoggedIn ? "You have been idle for 12 minutes. If you do not select Continue or you make no selection in 3 minutes and 0 seconds, you will be automatically logged out.":"You have been idle for 12 minutes. If you do not select Continue or you make no selection in 3 minutes and 0 seconds, your session will be refreshed and you may lose any unprocessed information."); InstaMed.query("IdleTimerNotification") & InstaMed.query("IdleTimerNotification").setTitle && InstaMed.query("IdleTimerNotification").setTitle(InstaMed.isLoggedIn ? "Automatic Logout":"Inactivity Alert"); } },show: function(cmp) { Ext.each(Ext.DomQuery.select('.x-panel-body', Ext.DomQuery.selectNode('.x-window[id=NavPageIdleTimeoutForm]')), function(p) { Ext.get(p.id).scrollTo('top', 0); }); }}, items: [ { xtype: 'form', preventHeader: true, bodyCls: 'mypanel', api: { submit: IdleTimerController.submit }, defaultSubmitButton: 'btnContinue', name: 'MyFormPanel', ui: 'flat', itemId: 'MyFormPanel', flex: 1, cls: 'flat', scrollable: null, id: 'MyFormPanel_6', items: [ {xtype: 'errorbox', name: 'ValidationSummary', ui: 'ErrorBox', flex: 1, hidden: true, cls: 'ErrorBox', id: 'ValidationSummary_28' }, {xtype: 'label', html: 'You have been idle for 12 minutes. If you do not select Continue or you make no selection in 3 minutes and 0 seconds, your session will be refreshed and you may lose any unprocessed information.', name: 'IdleTimerNotification', flex: 1, id: 'MyFormPanel_IdleTimerNotification' }, {xtype: 'container', flex: 1, scrollable: null, id: 'MyFormPanel_container_12', items: [ {xtype: 'container', layout: {type: 'hbox', pack: 'start', align: 'bottom'}, flex: 1, cls: 'buttonContainer', scrollable: null, id: 'MyFormPanel_container_13', items: [ {xtype: 'spacer', flex: 1, id: 'MyFormPanel_spacer_7' }, {xtype: 'button', text: 'Logout', name: 'Logout', ui: 'secondary', flex: 1, margin: '', hidden: true, ariaRole: 'button', cls: 'secondary noprint', id: 'MyFormPanel_button_Logout', listeners: {tap: function() { LogoutTimer.logOut(); }} }, {xtype: 'button', text: 'Continue', name: 'btnContinue', ui: 'secondary', flex: 1, margin: '', ariaRole: 'button', cls: 'secondary noprint', id: 'MyFormPanel_button_Continue', listeners: {tap: function(cmp, newValue, oldValue, eOpts) {LogoutTimer.resetMainTimer(); myForm = InstaMed.findParentForm(cmp);PerformAction(myForm.getValues(),IdleTimerController.submit,cmp);}} }] }] }] }] }] }});Ext.Loader.setConfig({ enabled: false});Ext.application({ name: 'MyApp', launch: function() { Ext.create('MyApp.view.NavigationView', {fullscreen: true}); }});LogoutTimer & setTimeout(LogoutTimer.reinitiateMainTimer,5000);}

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